Advances in preoperative assessment of liver function

doi:10.1016/S1499-3872(14)60267-8

Hepatobiliary & Pancreatic Diseases International

Volume 13, Issue 4, 15 August 2014, Pages 361-370

https://doi.org/10.1016/S1499-3872(14)60267-8 Get rights and content

Background

Postoperative liver failure remains a life-threatening complication. Preoperative evaluation of liver function is essential in reducing the complications after hepatectomy. However, it is difficult to accurately evaluate liver function before surgery because of the limitations of the liver function tests available. Recent advances in liver function tests improved the ability to assess liver function. The present review was to analyze these methods and their advantages.

Data Sources

MEDLINE was searched using the terms of “liver function test”, “liver function evaluation” and “galactosyl serum albumin”. Relevant articles published in English and Chinese from 1961 to 2014 were reviewed.

Results

Although serological tests are used frequently in practice, they reflect the degree of total liver damage or function, not the remnant of liver function. Child-Pugh score and model for end-stage liver disease (MELD) score assess whole liver function, and are particularly useful in determining whether patients with hepatocellular carcinoma and cirrhosis are candidates for resection or transplantation, but cannot determine the safe extent or removal. The indocyanine green and other metabolic quantitative liver function tests can evaluate functional hepatocytes, making them more accurate in predicting liver function. Computed tomography (CT) volumetry can provide anatomic information on the remnant liver volume but not on functional volume. ^99mTc-galactosyl serum albumin scintigraphy, combined with single photon emission computed tomography, CT and three-dimensional reconstruction, may be a better quantitative measure of liver function, especially of remnant liver function.

Conclusions

Tests used to evaluate liver functional reserve and to predict surgical risk have limitations. ^99mTc-galactosyl serum albumin scintigraphy, which can more accurately evaluate the whole and regional liver function, may be promising in predicting resection margins and risks of liver failure.

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Prediction of post-hepatectomy liver failure by preoperative gadoxetate disodium-enhanced magnetic resonance imaging
2024, HPB
Approximately 15% of patients experience post-hepatectomy liver failure after major hepatectomy. Poor hepatocyte uptake of gadoxetate disodium, a magnetic resonance imaging contrast agent, may be a predictor of post-hepatectomy liver failure.
A retrospective cohort study of patients undergoing major hepatectomy (≥3 segments) with a preoperative gadoxetate disodium-enhanced magnetic resonance imaging was conducted. The liver signal intensity (standardized to the spleen) and the functional liver remnant was calculated to determine if this can predict post-hepatectomy liver failure after major hepatectomy.
In 134 patients, low signal intensity of the remnant liver standardized by signal intensity of the spleen in post-contrast images was associated with post-hepatectomy liver failure in multiple logistic regression analysis (Odds Ratio 0.112; 95% CI 0.023–0.551). In a subgroup of 33 patients with lower quartile of functional liver remnant, area under the curve analysis demonstrated a diagnostic accuracy of functional liver remnant to predict post-hepatectomy liver failure of 0.857 with a cut-off value for functional liver remnant of 1.4985 with 80.0% sensitivity and 89.3% specificity.
Functional liver remnant determined by gadoxetate disodium-enhanced magnetic resonance imaging is a predictor of post-hepatectomy liver failure which may help identify patients for resection, reducing morbidity and mortality.
The Effects of Apocynin on Monosodium Glutamate Induced Liver Damage of Rats
2023, Heliyon
Monosodium glutamate (MSG) is found in refined foods. Apocynin (APO) is a selective NADPH oxidase (NOX) inhibitor. The aim of this experimental study was to investigate possible effects of MSG and the curative effects of APO in rats. Twenty-eight male Sprague-Dawley rats were randomly divided into four groups (Normal control, APO, MSG and MSG + APO, n:7 for each group). The MSG and MSG + APO groups received 120 mg/kg MSG solution orally for 28 consecutive days. The APO and MSG + APO groups received 25 mg/kg APO solution orally for 5 days until the end of the experiment. At the end of the experiment, all rats were sacrificed and liver tissue and blood samples were taken for histological, ultrastructural, and biochemical analyses. In the MSG group, vacuolization and loss in glycogen content in the hepatocytes, leukocyte infiltration and fibrosis in the liver parenchyme and portal triads, were observed. Terminal deoxynucleotidyl transferase dUTP (TUNEL)-positivity and NADPH oxidase (NOX)-2-positivity were higher in the MSG group compared with the other experimental groups. The concentrations of alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), total bilirubin, malondialdehyde (MDA), and myeloperoxidase (MPO) were higher, whereas albumin, glutathione (GSH), and superoxide (SOD) levels were lower in the MSG group. All these data has been reversed in MSG + APO group. The histological and biochemical criteria indicated the prominent ameliorating effect of APO on MSG -induced liver injury.
Establishment of a risk assessment system for complications of hepatectomy based on preoperative variables
2022, iLIVER
To reduce the incidence of postoperative complications, it is important to predict them and intervene before surgery if necessary. However, there is no ideal system to evaluate the overall risk of postoperative complications of liver surgery on the basis of preoperative variables. Therefore, this study aimed to design and validate a risk assessment system to predict postoperative complications of hepatectomy on the basis of preoperative variables.
Binomial logistic regression was used to derive the “hepatectomy overall risk formula” (HORF) for predicting postoperative complications on the basis of preoperative variables.
Multivariate analysis revealed that Child–Pugh grade B–C (odds ratio [OR] = 1.984, p = 0.002), medical diseases requiring drug treatment (OR = 1.883, p = 0.003), major hepatectomy (OR = 1.947, p < 0.001), adjacent organ invasion (OR = 3.616, p = 0.023), and preoperative hospital stay >7 days (OR = 1.565, p = 0.004) were independent risk factors for postoperative complications of hepatectomy. The area under the curve for the HORF was 0.736. The optimal cut-off value for predicting complications was 0.32 (32%). The area under the curve for the HORF in the validation dataset was 0.727.
The HORF can accurately predict postoperative complications of hepatectomy on the basis of preoperative variables, and thus enables the determination of the necessity for intervention before surgery.
Gadoxetic Acid Uptake Rate as a Measure of Global and Regional Liver Function as Compared With Indocyanine Green Retention, Albumin-Bilirubin Score, and Portal Venous Perfusion
2022, Advances in Radiation Oncology
Citation Excerpt :
Using this strategy, separate patients cannot be assumed to have the uniform liver function and radiation dose response. Furthermore, a patient cannot be assumed to have homogeneous hepatic function and dose-response throughout the liver.6-10 These approaches require measures of global and regional liver function as well as radiation dose response in individual patients while considering all these factors in treatment planning.
Global and regional liver function assessments are important for defining the magnitude and spatial distribution of dose to preserve functional liver parenchyma and reduce incidence of hepatotoxicity from radiation therapy for intrahepatic cancer treatment. This individualized liver function-guided radiation therapy strategy is critical for patients with heterogeneous and poor liver function, often observed in cirrhotic patients treated for hepatocellular carcinoma. This study aimed to validate k₁ as a measure of global and regional function through comparison with 2 well-regarded global function measures: indocyanine green retention (ICGR) and albumin-bilirubin (ALBI).
Seventy-nine dynamic gadoxetic acid enhanced magnetic resonance imaging scans were acquired in 40 patients with hepatocellular carcinoma in institutional review board approved prospective protocols. Portal venous perfusion (k_pv) was quantified from gadoxetic acid enhanced magnetic resonance imaging using a dual-input 2-compartment model, and gadoxetic acid uptake rate (k₁) was fitted using a linearized single-input 2-compartment model chosen for robust k₁ estimation. Four image-derived measures of global liver function were tested: (1) mean k₁ multiplied by liver volume (k₁V_L) (functional volume), (2) mean k₁ multiplied by blood distribution volume (k₁V_dis)_, (3) mean k_pv, and (4) liver volume (V_L). The measure's correlation with corresponding ICGR and ALBI tests was assessed using linear regression. Voxel-wise similarity between k₁ and k_pv was compared using Spearman ranked correlation.
Significant correlations (P < .05) with ICGR and ALBI were found for k₁V_L, k₁V_dis, and V_L (in order of strength), but not for mean $k$ _pv $.$ The mean ranked correlation coefficient between k₁ and k_pv maps was 0.09. k₁ and k_pv maps were predominantly mismatched in patients with poor liver function.
The metric combining function and liver volume (k₁V_L) was a stronger measure of global liver function compared with perfusion or liver volume alone, especially in patients with poor liver function. Gadoxetic acid uptake rate is promising for both global and regional liver function.
Value of Liver Function Tests in Cirrhosis
2022, Journal of Clinical and Experimental Hepatology
The liver comprises both parenchymal and non-parenchymal cells with varying functions. Cirrhosis is often complicated by the development of portal hypertension and its associated complications. Hence, assessment of liver in cirrhosis should include assessment of its structural, function of both hepatic and non-hepatic tissue and haemodynamic assessment of portal hypertension. There is no single test that can evaluate all functions of liver and assess prevalence and severity of portal hypertension. Commonly available tests like serum bilirubin, liver enzymes (alanine [ALT] and aspartate aminotransferase [AST], serum alkaline phosphatase [ALP], gamma glutamyl transpeptidase [GGT]), serum albumin and prothrombin time for assessment of liver functions partly assess liver functions. quantitative liver functions like indocyanine clearance tests [ICG-K], methacetin breath test [MBT] were developed to assess dynamic status of liver but has its own limitation and availability. Imaging based assessment of liver by transient elastography, MRI based 99 mTc-coupled asialoglycoprotein mebrofenin scan help the clinician to assess liver function, functional volume of liver left after surgery and portal hypertension [PH]. Hepatic venous pressure gradient still remains the gold standard for the assessment of portal hypertension but is invasive and not available in all centres. Combinations of blood parameters in form of various indices like fibrosis score of 4 [FIB-4], Lok index, scores like model for end stage liver disease (MELD) and Child-Turcotte Pugh score are commonly used for assessing liver function in clinical practice.
Future liver remnant function as a predictor of postoperative morbidity following liver resection for hepatocellular carcinoma – A risk factor analysis
2020, Surgical Oncology
Citation Excerpt :
Apart from volume/function analysis, preoperative laboratory parameters are routinely used to estimate liver function, but are more reflective of the degree of hepatic damage than of global liver function [36]. Scoring systems such as MELD score and CTP score has been tested in a variety of clinical settings ranging from survival to quality of life, but have failed to predict postoperative outcome [36,47,48]. In line with these findings, preoperative laboratory parameters and MELD score were not predictive of postoperative morbidity in this study (Tables 2–4).
Advances in anaesthesia and surgical technique have considerably reduced mortality in hepatocellular carcinoma (HCC) patients undergoing liver resection. However, extended resections in patients with liver cirrhosis still represent a challenge. The aim of this study was to investigate the predictive value of volume/function analysis for the prediction of morbidity in HCC patients following liver resection.
Between 2001 and 2014, a total of 261 patients who underwent open hepatectomy for HCC were enrolled in this study. Future liver remnant volume (FLRV) and future liver remnant function (FLRF) based on LiMAx testing were obtained retrospectively. Uni- and multivariable analyses were performed to identify predictors for postoperative ascites, post-hepatectomy haemorrhage (PHH), and wound healing disorders (WHD) within the total cohort and in a subgroup of cirrhotic patients.
The most commonly observed complication was ascites (57.1%), followed by liver failure (25.3%), PHH (19.5%), and WHD (19.2%). FLRF was a major predictor of postoperative ascites (AUC 0.776; OR 0.987, p = 0.001), PHH (AUC 0.717; OR 0.984, p = 0.001), and WHD (AUC 0.660; OR 0.994, p = 0.032) in total cohort. Multivariable analysis of the cirrhosis subgroup showed FLRF to be an independent predictor of ascites (AUC 0.814; OR 0.989, p = 0.021), PHH (AUC 0.677; OR 0.991, p = 0.040), and WHD (AUC 0.615; OR 0.989, p = 0.033).
FLRF is a major predictor of postoperative ascites, haemorrhage, and wound healing disorders in cirrhotic and non-cirrhotic patients whereas FLRV failed to show significant correlations. Preoperative calculation of FLRF may augment surgical decision-making in high-risk patients and thereby improve perioperative outcome.

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: Published online June 23, 2014.

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Review ArticleAdvances in preoperative assessment of liver function

Background

Data Sources

Results

Conclusions

Lancet

Lancet Oncol

Gastroenterology

Surg Clin North Am

Lancet

J Hepatol

Transplant Proc

Hepatology

J Gastrointest Surg

J Gastrointest Surg

Methods Enzymol

Surgery

Hepatol Res

Surgery

Am J Gastroenterol

J Gastrointest Surg

Liver transplantation for hepatocellular carcinoma

Hepatobiliary Surg Nutr

Risk factors of posthepatectomy liver failure after portal vein embolization

J Hepatobiliary Pancreat Surg

Strategies for safer liver surgery and partial liver transplantation

N Engl J Med

Sepsis-induced cholestasis

Hepatology

Hepatocellular carcinoma

Surgery and portal hypertension

Major Probl Clin Surg

Transection of the oesophagus for bleeding oesophageal varices

Br J Surg

A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts

Hepatology

The model for end-stage liver disease allocation system for liver transplantation saves lives, but increases morbidity and cost: a prospective outcome analysis

Liver Transpl

Hyponatremia and mortality among patients on the liver-transplant waiting list

N Engl J Med

Comparison of four model for end-stage liver disease-based prognostic systems for cirrhosis

Liver Transpl

Preoperative liver function assessments to estimate the prognosis and safety of liver resections

Surg Today

Splitting liver grafts for two adults: suboptimal grafts or suboptimal matching?

Hepatobiliary Surg Nutr

The handling of indocyanine green by the liver

Schweiz Med Wochenschr

Real-time intraoperative assessment of residual liver functional reserve using pulse dye densitometry

World J Surg

Identifying a long standing error in single-bolus determination of the hepatic extraction ratio for indocyanine green

Eur J Appl Physiol

Kinetic analysis of hepatobiliary transport of organic anions in Eisai hyperbilirubinemic mutant rats

J Pharmacol Exp Ther

Pharmacokinetic modeling of the hepatobiliary transport mediated by cooperation of uptake and efflux transporters

Drug Metab Rev

Review Article
Advances in preoperative assessment of liver function