Enzymatic liver function measured by LiMAx is superior to current standard methods in predicting transplant-free survival after TIPS implantation

Abstract

Transjugular intrahepatic portosystemic shunt (TIPS) is one of the main treatment options in patients with decompensated liver cirrhosis but is still associated with partly severe complications. For adequate patient selection, prognostic parameters are of crucial importance. The liver maximum capacity (LiMAx) breath test measures enzymatic liver function and could potentially represent an efficient prognostic marker. We therefore aimed to assess the role of LiMAx in predicting survival of TIPS patients in a prospective analysis. LiMAx was performed for patients who underwent TIPS implantation between October 2016 and February 2018. Associations with transplant-free survival after 24 weeks were assessed by logistic regression. A total number of 30 patients were included, of whom seven received liver transplantation (N = 2) or died (N = 5) during follow-up. LiMAx values after (P = 0.01, OR = 1.24, 95% CI = 1.04–1.47) and before (P = 0.03, OR 1.21, 95% CI = 1.02–1.43) TIPS implantation and MELD score (P = 0.03, OR = 0.79, 95% CI = 0.63–0.98) were significantly associated with transplant-free survival according to univariate logistic regression. In AUROC analysis, LiMAx at day one after TIPS (sensitivity 85.7%, specificity 78.3%, AUROC 0.85, cut-off ≤ 165 µg/kg/h), LiMAx value at the day before TIPS (sensitivity 100%, specificity 73.9%, AUROC 0.82, cut-off ≤ 205 µg/kg/h) and MELD score (sensitivity 71.4%, specificity 73.9%, AUROC 0.82, cut-off ≥ 15) had the highest prognostic accuracy. LiMAx values prior and after TIPS procedure seem to be good prognostic parameters regarding prediction of transplant-free survival of patients undergoing TIPS implantation.

LiMAx Prior to Radioembolization for Hepatocellular Carcinoma as an Additional Tool for Patient Selection in Patients with Liver Cirrhosis

“…In transplantation-medicine, LiMAx ® showed robust results in predicting the risk of graft dysfunction after liver transplantation [ 27 ]. Recently, LiMAx ® was also investigated as an additional tool for patient selection prior to transjugular intrahepatic portosystemic shunt implantation [ 28 ]. In HCC patients, LiMAx ® has shown promising results in assessing liver function after TACE and was more accurate than the Child–Pugh score [ 12 , 13 ].…”

Transjugular Intrahepatic Portosystemic Shunt Placement: Effects on Nutritional Status in Cirrhotic Patients

“…However, hepatic encephalopathy represents a frequent complication of TIPS [33] affecting quality of life, requiring frequent hospitalizations, and sometimes the reduction of the caliber of the stent. Therefore, patient selection for TIPS requires careful assessment of risk factors for HE [34][35][36]. The search for the ideal candidate should take into account multiple parameters such as the history of HE and the presence of minimal HE, the comorbidities and age of the patient, liver and renal function, as well as the presence of alterations of nutritional status (i.e., sarcopenia and myosteatosis) [37].…”

Liver Function—How to Screen and to Diagnose: Insights from Personal Experiences, Controlled Clinical Studies and Future Perspectives

“…Therefore, an adequate selection of patients suitable for a certain intervention is of fundamental importance. The LiMAx test was able to estimate prognosis with regard to liver surgery, transjugular intrahepatic portosystemic shunt (TIPS) or liver cancer therapies such as transarterial chemotherapy (TACE) or selective intra-arterial radiotherapy (SIRT; unpublished data) and decline from patients who will not benefit from these procedures [ 83 , 96 , 97 , 98 , 99 , 100 , 101 ]. However, it is not only possible to individually decide whether a certain intervention is possible but also to determine an appropriate timepoint.…”