A rapid and accurate new bedside test to assess maximal liver function: a case report

Area of Science:

• Hepatology
• Surgical Oncology
• Diagnostic Imaging

Background:

• Accurate preoperative assessment of residual liver function is critical in liver surgery.
• Post-hepatectomy liver failure is a significant cause of mortality.
• Existing methods for predicting postoperative liver function are limited.

Observation:

• A novel bedside test, LiMAx, measures the enzymatic capacity of cytochrome P450 1A2.
• The LiMAx test involves administering (13)C-labeled methacetin and analyzing exhaled breath for (13)CO2/(12)CO2 ratios.
• In a patient with a cecal carcinoma and liver metastasis, a laparoscopic right hemihepatectomy was planned based on CT volumetry and predicted LiMAx values.

Findings:

• The LiMAx test accurately predicted postoperative liver function in the presented case.
• The predicted LiMAx value of 301 μg/kg/h closely matched the actual postoperative value of 316 μg/kg/h.
• A LiMAx value above 315 μg/kg/h indicates normal liver function.

Implications:

• The combination of the LiMAx test and CT-volumetry offers a precise method for preoperative liver function prediction.
• This integrated approach may significantly improve preoperative patient evaluation for liver surgery.
• Enhanced prediction of liver function can lead to better surgical planning and improved postoperative outcomes, reducing mortality associated with liver failure.