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Assessment of pretransplant prognosis in patients with cirrhosis
M Oellerich1, M Burdelski, H U Lautz
1Institut für Klinische Chemie, Medizinische Hochschule Hannover, Federal Republic of Germany.
Insights
Dynamic liver function tests, including monoethylglycinexylidide (MEGX) formation and indocyanine green (ICG) half-life, significantly predict short-term survival in cirrhosis patients. These tests outperform traditional liver function assessments for transplant candidates.
Area of Science:
- Hepatology
- Transplantation Medicine
- Clinical Biochemistry
Background:
- Cirrhosis poses a significant challenge in liver transplantation, necessitating accurate prognostic tools.
- Traditional liver function tests and clinical scores have limitations in predicting short-term outcomes for patients with cirrhosis.
Purpose of the Study:
- To evaluate the prognostic value of dynamic liver function tests (monoethylglycinexylidide (MEGX) and indocyanine green (ICG)) compared to traditional methods in patients with cirrhosis awaiting liver transplantation.
- To assess the predictive accuracy of these tests across different patient subgroups (adults, pediatric, postnecrotic cirrhosis, biliary cirrhosis).
Main Methods:
- Prospective study involving 164 patients with cirrhosis (107 adult, 57 pediatric).
- Assessed MEGX formation from lidocaine, ICG half-life, bilirubin, albumin, cholinesterase, alkaline phosphatase, prothrombin time, ascites, and Pugh score.
- Utilized Cox proportional hazards regression for survival analysis.
Main Results:
- Both MEGX and ICG tests showed a significant relationship with 120-day survival in all analyzed subgroups.
- MEGX and ICG test results were superior to conventional tests and Pugh score in predicting short-term prognosis.
- No other tested parameters significantly improved predictive ability when MEGX and ICG were included.
Conclusions:
- Dynamic liver function tests, specifically MEGX and ICG, offer superior short-term prognostic accuracy for cirrhotics compared to traditional methods.
- These findings have implications for optimizing the timing of liver transplantation.
Abstract:
The objective of this prospective study was to assess the prognostic value of dynamic liver function tests and traditional methods of evaluating liver function in potential candidates for hepatic transplantation. Patients who underwent orthotopic liver transplantation within the follow-up period of 120 days were excluded. The study included 107 adult and 57 pediatric patients with cirrhosis. Postnecrotic cirrhosis was present in 107 and biliary cirrhosis in 57 of 164 patients. During the follow-up period, 26 of 164 patients died of their liver disease. At the time of inclusion, we recorded monoethylglycinexylidide (MEGX) formation from lidocaine, indocyanine green (ICG) half-life, bilirubin and albumin serum concentration, activity of cholinesterase and alkaline phosphatase, prothrombin time, the clinical complication of ascites, and--in adults--the Pugh score also. These variables were subjected as covariates to a survival analysis (Cox proportional hazards regression model) using separately the data from adults, pediatric patients, all patients with postnecrotic cirrhosis, and all patients with biliary cirrhosis. In all of these four subgroups there was a significant relationship between MEGX and ICG test results and the 120-day survival. In the stepwise analysis, none of the remaining parameters contributed to a further relevant improvement of our predictive ability when added to the values of ICG and MEGX. Our results suggest that the ICG and the MEGX test are superior to conventional liver function tests and the Pugh score in assessing short-term prognosis in cirrhotics independently from the etiology of the underlying liver disease. These findings may have important implications for determining the optimum timing of transplantation.