Quantitative evaluation of liver function by the methionine and aminopyrine breath tests in the early stages of liver transplantation

Abstract

Objective The early phase after liver transplant is considered the period of greatest risk for graft failure. In recent years breath tests have been proposed as a noninvasive method to assess liver function. In particular, the aminopyrine breath test is useful for evaluating the liver viable mass, and the methionine breath test could be used to evaluate oxidative capacity of liver mitochondria. We aimed to perform these tests in the early phase following liver transplant in order to correlate the time course of these tests to the outcome of transplantation.Methods Twenty-three patients undergoing liver transplant were enrolled. The methionine and aminopyrine breath tests were performed on the days 1, 3 and 5, and 2, 4 and 6, respectively, after transplant. Results were expressed as the percentage of administered 13 C recovered per hour and as the cumulative percentage of the 13 C dose recovered over the test period.Results All but two transplants were successful in the short term and the cumulative percentage of the dose of 13 C progressively increased after transplantation, reaching values not significantly different from controls (methionine at day 5). In two patients, primary non-function occurred: in these patients the cumulative percentage of the 13 C dose did not increase after orthotopic liver transplant and the results of both breath tests indicated that it always remained significantly lower compared to that of other patients.Conclusions A combination of breath tests, exploring both mitochondrial and microsomal function, could be useful in the early phase after liver transplant in order to evaluate the graft outcome. Eur J Gastroenterol Hepatol

13C‐methacetin breath test for monitoring hepatic function in cirrhotic patients before and after liver transplantation

“…We agree with the authors that 13 C breath testing may be useful for monitoring hepatic function in patients waiting for orthotopic liver transplantation and during follow‐up after this procedure, as described in a recent paper 2 . In particular, we have shown that 13 C‐aminopyrine and 13 C‐methionine breath tests are useful in the early phases after orthotopic liver transplantation to predict primary non‐function of the transplanted liver 2 . However, we prefer to use the 13 C‐aminopyrine breath test for the investigation of liver function in end‐stage cirrhotic patients, which, in our opinion, is more reliable than the 13 C‐methionine breath test.…”

“…in a recent issue of Alimentary Pharmacology and Therapeutics 1 . We agree with the authors that 13 C breath testing may be useful for monitoring hepatic function in patients waiting for orthotopic liver transplantation and during follow‐up after this procedure, as described in a recent paper 2 . In particular, we have shown that 13 C‐aminopyrine and 13 C‐methionine breath tests are useful in the early phases after orthotopic liver transplantation to predict primary non‐function of the transplanted liver 2 .…”

Klinisch relevante Atemtests in der gastroenterologischen Diagnostik - Empfehlungen der Deutschen Gesellschaft für Neurogastroenterologie und Motilität sowie der Deutschen Gesellschaft für Verdauungs- und Stoffwechselerkrankungen

“…Über die oben genannten Substrate hinaus wurden 13 C-Phenylalanin [222, 236 -239], 13 C-Methionin [233,240,240,241], 13 C-Koffein [242], 13 C-Galaktose [243] und 13 C-Oktansäure [244] zur Messung der hepatischen Funktion eingesetzt. Mit den entsprechenden Atemtests lässt sich in der Regel eine sichere Diffe-renzierung zwischen Patienten mit einer chronischen Lebererkrankung und Gesunden [222,234,236] bzw.…”

900 13C-Methionine Breath Test to Assess Intestinal Failure Associated Liver Disease

“…The enteral version of the MBT has been shown to correlate with both hepatic steatosis and cirrhosis in adults (27). Similarly, adult liver transplant outcomes (28) and HIV patient drug-induced hepatic toxicity (18) have been predicted by an orally administered [ 13 C]-MBT. Furthermore, in HIV-infected adults, oral [ 13 C]-MBT results were shown to be an earlier marker of hepatic mitochondrial dysfunction than either standard liver function tests or patient symptomatology (29).…”