Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jan 23;12(2):254.
doi: 10.3390/biomedicines12020254.

Perioperative LiMAx Test Analysis: Impact of Portal Vein Embolisation, Chemotherapy and Major Liver Resection

Felix Rühlmann  1 , Azadeh Azizian  1 , Christian Moosmann  1 , Markus Bernhardt  1 , Jan Keck  1 , Hannah Flebbe  1 , Omar Al-Bourini  2 , Ali Seif Amir Hosseini  2 , Marian Grade  1 , Thomas Lorf  1 , Michael Ghadimi  1 , Thorsten Perl  1 , Jochen Gaedcke  1
Affiliations

Perioperative LiMAx Test Analysis: Impact of Portal Vein Embolisation, Chemotherapy and Major Liver Resection

Felix Rühlmann et al. Biomedicines. .

Abstract

Background: Postoperative liver failure (PLF) is a severe complication after major liver resection (MLR). To increase the safety of patients, clinical bedside tests are of great importance. However, limitations of their applicability and validity impair their value.

Methods: Preoperative measurements of the liver maximum capacity (LiMAx) were performed in n = 40 patients, who underwent MLR (≥3 segments). Matched postoperative LiMAx was measured in n = 21 patients. Liver function was compared between pretreated patients (n = 11 with portal vein embolisation (PVE) and n = 19 patients with preoperative chemotherapy) and therapy naïve patients. The LiMAx values were compared with liver-specific blood parameters and volumetric analysis.

Results: In total, n = 40 patients were enrolled in this study. The majority of patients (n = 33; 82.5%) had high preoperative LiMAx values (>315 µg/kg/h), while only seven patients (17.5%) had medium values (140-315 µg/kg/h), and none of the patients had low values (<140 µg/kg/h). A comparison of pretreated patients (with PVE and/or chemotherapy) and therapy naïve patients showed no significant difference in the preoperative LiMAx values (p > 0.05). The preoperative LiMAx values were significantly higher than the matched postoperative values on postoperative day 1 (p < 0.0001). A comparison between the expected and measured postoperative LiMAx showed a difference (≥10%) in 7 out of 13 patients (53.8%). After an initial postoperative decrease in the LiMAx, the patients without complications (n = 12) showed a continuous increase until 14 days after surgery. In the patients with postoperative complications, a decrease in the LiMAx was associated with a prolonged recovery.

Conclusions: For patients undergoing MLR within the 0.5% rule, which is the clinical gold standard, the LiMAx values do not offer any additional information. Additionally, the LiMAx may have reflected liver function, but it did not deliver additional information regarding postoperative liver recovery. The clinical use of LiMAx might be relevant in selected patients beyond the 0.5% rule.

Keywords: LiMAx test; liver function test; major liver resection; perioperative risk assessment; portal vein embolisation; postoperative liver failure.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
(A) Preoperative LiMAx values in patients with and without preoperative chemotherapy (p > 0.05). (B) Preoperative LiMAx values in patients with and without preoperative PVE (p > 0.05). (C) Preoperative Quick values in patients with and without preoperative chemotherapy (p > 0.05). (D) Preoperative bilirubin levels in patients with and without preoperative chemotherapy (p > 0.05). (E) Preoperative Quick values in patients with and without preoperative PVE (p > 0.05). (F) Preoperative bilirubin levels in patients with and without preoperative PVE (p > 0.05).
Figure 2
Figure 2
Comparison between preoperative LiMAx and matched postoperative LiMAx values on POD1 (p < 0.0001). ****: p < 0.0001.
Figure 3
Figure 3
Development of LiMAx values preoperatively and postoperatively in patients undergoing liver resections without postoperative surgical complications. Each colour represents an individual patient.
Figure 4
Figure 4
Development of LiMAx values preoperatively and postoperatively in patients undergoing liver resections with postoperative surgical complications. Each colour represents an indidivual patient.
See this image and copyright information in PMC

References

    1. Schneider P.D. Preoperative assessment of liver function. Surg. Clin. N. Am. 2004;84:355–373. doi: 10.1016/S0039-6109(03)00224-X. - DOI - PubMed
    1. van den Broek M.A., Damink S.W.M.O., Dejong C.H.C., Lang H., Malagó M., Jalan R., Saner F.H. Liver failure after partial hepatic resection: Definition, pathophysiology, risk factors and treatment. Liver Int. 2008;28:767–780. doi: 10.1111/j.1478-3231.2008.01777.x. - DOI - PubMed
    1. Guglielmi A., Ruzzenente A., Conci S., Valdegamberi A., Iacono C. How much remnant is enough in liver resection? Dig. Surg. 2012;29:6–17. doi: 10.1159/000335713. - DOI - PubMed
    1. Jarnagin W.R., Gonen M., Fong Y., DeMatteo R.P., Ben-Porat L., Little S., Corvera C., Weber S., Blumgart L.H. Improvement in perioperative outcome after hepatic resection: Analysis of 1803 consecutive cases over the past decade. An. Surg. 2002;236:397–406. doi: 10.1097/00000658-200210000-00001. - DOI - PMC - PubMed
    1. Rahbari N.N., Garden O.J., Padbury R., Brooke-Smith M., Crawford M., Adam R., Koch M., Makuuchi M., Dematteo R.P., Christophi C., et al. Posthepatectomy liver failure: A definition and grading by the International Study Group of Liver Surgery (ISGLS) Surgery. 2011;149:713–724. doi: 10.1016/j.surg.2010.10.001. - DOI - PubMed

LinkOut - more resources