[Prognostic factors in liver transplantation. Is the lidocaine test usefull?]

With continuous development of liver transplantation, the need of better tests for selecting donors and improving diagnosis of postransplant hepatic dysfunction, is increasing.

To determine the prognostic value of a number of parameters, including the lidocaine test (MEGX) in selecting donors, and assessing the efficacy of this test in the postransplant follow-up as an indicator of morbidity and mortality.

A consecutive series of forty donor-receptor pairs was studied for six months postransplant. In addition to the lidocaine test, different clinical, analytical and histological variables were analysed. Death, retransplantation, graft dysfunction and days in hospital were considered as indicators of morbimortality.

Among the variables selected by univariate analysis, only ALT value at day 1 and Child-Pugh score at day 7 reached independent prognostic value in a Cox's regression model. However, both a cut-off level of 50 ng/ml for MEGX in donors and 40 ng/ml for MEGX test at day 1 postransplant, allowed to identify statistically different survival curves (p < 0.05). The lidocaine test at day 7 showed a significant association with the number of rejection episodes.

ALT value at day 1 and Child-Pugh score at day 7 turned out to be the only variables with independent prognostic value for survival during the first six months postransplant. The MEGX value may be of help in selecting donors and a subgroup of receptors (day 1 < 40 ng/ml) with a high risk of mortality.