The clinical importance of conventional and quantitative liver function tests in liver transplantation

The advantages and disadvantages of using monoethylglycinexylidide (MEGX), the major metabolite of lidocaine, as a probe of hepatic function in liver transplantation are reviewed. A 'real time' test of liver function should give a measure of current hepatocellular capacity rather than reflect past damage. The hepatic metabolism of lidocaine to MEGX is the basis of a flow-dependent dynamic test of liver function. In pre-transplantation patients, data from this MEGX test support its role in assessing the risk of morbidity and mortality. In assessing the liver transplant donor, there are differences concerning its apparent usefulness and these must be resolved. In the liver transplant recipient, this MEGX test is also useful for measuring real-time hepatic metabolizing activity, and low MEGX values reflect the clinical condition of the patient. At present, however, this test has several limitations. Therefore, a comprehensive evaluation, not only by the MEGX test but also by a combination of other conventional liver function tests (biochemical parameters, etc.), or with histological evaluation, is thought to be desirable for deciding whether a liver transplantation should be carried out or not.