Application of the Liver Maximum Function Capacity Test in Acute Liver Failure: A Helpful Tool for Decision-Making in Liver Transplantation?

Abstract

Background. Despite aggressive intensive medical management acute liver failure (ALF) may require high-urgency liver transplantation (LTx). Available prognostic scores do not apply for all patients; reliable tools to identify individuals in need of LTx are highly required. The liver maximum function capacity test (LiMAx) might represent an appropriate option. Referring to a case of ALF after Amanita phalloides-intoxication the potential of the LiMAx-test in this setting is discussed. Presentation of Case. LiMAx was performed in a 27-year-old patient prior to and after high-urgency LTx. In accordance with clinical appearance of hepatic encephalopathy, coagulopathy, and acute kidney failure, the LiMAx-test constituted a fulminant course of ALF with hardly any detectable metabolic activity. Following LTx with a marginal donor organ (95% hepatosteatosis), uptake of liver function was demonstrated by postoperative increase of the LiMAx-value. The patient was discharged from hospital on postoperative day 26. Discussion. ALF often is associated with a critical state of the patient that requires almost immediate decision-making regarding further therapy. Application of a noninvasive liver function test might help to determine the prognosis of ALF and support decision-making for or against LTx as well as acceptance of a critical donor organ in case of a critically ill patient.

Performance of the Liver Maximum Function Capacity Test, Fibrinogen, and Transient Elastography in Patients with Acute Liver Injury

“…Accordingly, LiMAx was suggested as a potential marker for the outcome of ALF and achieved promising results in a retrospective pilot study of 12 patients with ALF. The performance of the LiMAx in ALF has been assessed in a porcine model for ALF [15] and in several case reports by our group and others [14, 16-18]. The aim of the present monocentric study was to expand data on the prognostic potential of the LiMAx and its associations with TE results and serum concentrations of specific coagulation factors in a well-defined cohort of patients with nonacetaminophen-induced ALF and individuals with acute hepatitis (AH) without ALF.…”

Porcine model for the study of liver regeneration enhanced by non-invasive 13C-methacetin breath test (LiMAx test) and permanent portal venous access

“…The latter than can be determined in the exhaled air, and a ratio of 13 CO 2 / 12 CO 2 is built to eventually calculate the maximum liver function capacity [24, 25]. In the last years, several studies have been published regarding the use of the LiMAx test to predict mortality and perioperative liver function or sepsis-related liver failure [26–30], but to our knowledge no data exist about its application in a pig model.…”