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Prognostic value of the monoethylglycinexylidide liver function test in assessing donor liver suitability.

BACKGROUND: Liver graft assessment prior to transplantation continues to be controversial. Various donor organ parameters must be evaluated to ensure that the transplanted organ will function and that the number of organs discarded will be minimized. Recent attempts to quantify liver function have utilized the metabolism of lidocaine to monoethylglycinexylidide (MEGX), and the MEGX test has been employed to evaluate the functional characteristics of donor livers prior to transplantation, with conflicting results. OBJECTIVE: To ascertain the role of quantitating the metabolic rate of lidocaine in predicting the results of liver transplantation. METHODS: Consecutive liver donors (N = 37) underwent quantitation of the amount of lidocaine converted to MEGX at 15 minutes. The donor patients were divided arbitrarily into efficient and poor lidocaine metabolizers, and the results of liver transplantation were evaluated. RESULTS: Patients who received livers that produced MEGX values of 80 ng/mL or less in 15 minutes had no definable alteration in transplantation outcome compared with patients who received livers that were more efficient lidocaine metabolizers. In a collected series, 46 patients who received livers that produced MEGX values of 80 ng/mL or less had a 1-month graft survival rate of 89% (41/46), while 74 patients who received livers that produced MEGX values greater than 80 ng/mL had a 1-month graft survival rate of 86% (64/74). CONCLUSIONS: The MEGX test had no practical utility in predicting liver graft functional status.

Humans↗

Lignocaine metabolism and liver function testing in primary graft failure following orthotopic liver transplantation.

OBJECTIVE: To report the use of lignocaine and the measurement of its metabolite, monoethylglycinexylidide (MEGX), as a dynamic test of liver function. CLINICAL FEATURES: The conversion of lignocaine to MEGX has been used serially as a test of liver function in a liver transplant recipient for whom retransplantation was necessary because of primary non-function (PNF) of the initial graft. MEGX concentrations were markedly depressed with individual episodes of PNF, cardiac failure and rejection in this patient. CONCLUSION: The test provided useful additional supportive information in assessment of the patient and management of intercurrent problems following liver transplantation.

Female↗

Effect of the CD14 promoter polymorphism on liver function tests and its association with alcohol and obesity.

OBJECTIVE: To investigate the effect of the functional CD14 promoter polymorphism on serum liver function tests and abnormally elevated liver function tests in a general population sample. METHODS: We recruited 310 subjects at random from general practitioner lists in Surrey. A previously validated medical questionnaire was completed and a serum sample provided for estimation of liver function test and genotyping of CD14 promoter polymorphism. RESULTS: The TT polymorphism was associated with significantly reduced serum levels of alanine aminotransferase 0.49 (95% confidence interval 0.26-0.93), gamma-glutamyl transferase 0.49 (95% confidence interval 0.38-0.89) and aspartate aminotransferase 0.48 (95% confidence interval 10.38-0.89). The TT polymorphism was associated with a reduced frequency of liver function test abnormalities, especially gamma-glutamyl transferase (odds ratio 0.113; 0.015-0.851). CONCLUSION: The TT promoter polymorphism was associated with reduced serum levels of alanine aminotransferase, gamma-glutamyl transferase and aspartate aminotransferase in healthy patients, and a low level of liver function test abnormalities. The relationship with gamma-glutamyl transferase stands after correction for age, gender, obesity and alcohol consumption. This raises the possibility that this genotype may offer protection from the development of fatty liver disease.

Aged↗

Effect of ATP on liver function tests in experimental diabetes.

Liver function tests were performed in severe and mild diabetic rats and under the influence of ATP. In mild diabetics the serum cholesterol was significantly increased, while in severe diabetes the serum cholesterol was significantly lower than in mild diabetes. The decreased serum cholesterol in severe diabetes may be an indication for the development of fatty liver. The serum alkaline phosphatase and serum bilirubin were significantly increased in both the severe and mild diabetic states, while the thymol turbidity test was insignificantly changed in both states of diabetes. Serum albumin was significantly decreased in 10 days mild diabetes, while it was insignificantly changed in 48 hrs severe diabetic animals. The effect of ATP was investigated in mild diabetes. ATP resulted in a significant increase in serum albumin and a decrease in total globulins with the resultant increase in A/G ratio. The serum alkaline phosphatase exhibited a significant reduction under the influence of ATP. The elevated cholesterol of mild diabetic rats remained significantly elevated and was not reduced by ATP, though the fat content of the liver showed a significant reduction. This may be due to more rapid mobilisation of fat from the liver under the influence of ATP. ATP showed no significant effect on serum bilirubin and thymol turbidity test. the histopathological examination of the liver revealed that administration of ATP to alloxan diabetic rats had a beneficial effect. It resulted in disappearrance of the fat globules from the liver cells.

Adenosine Triphosphate↗

Liver function tests in surgical infection and malnutrition.

Liver function tests were studied in chronically infected surgical patients, patients who recovered from infection, nonseptic malnourished patients and healthy control subjects. Liver function tests were abnormal in the septic patients but returned to normal values upon recovery from infection despite persistent loss of body weight. Malnourished, nonseptic patients similarly had normal liver function tests. These findings suggest that infection rather than accompanying malnutrition is the major cause of the abnormal liver function tests commonly observed in chronically septic surgical patients. Standard liver function tests may be helpful both in the diagnosis of occult intra-abdominal sepsis and also in indicating the efficacy of its treatment.

Alkaline Phosphatase↗

The liver-spleen scan as a quantitative liver function test: correlation with liver severity at peritoneoscopy.

Sulfur colloid distribution on liver-spleen scan is determined by the perfused Kupffer cell mass. The perfused Kupffer cell mass is proportional to the perfused hepatocyte mass, but is less affected by acute changes in hepatocyte function. Thus, sulfur colloid distribution parameters (precisely measured by quantitative liver-spleen scan [QLSS]) may be an excellent test of the perfused hepatic mass. Although no gold standard exists for confirmation, a close correlation should exist between liver disease severity assessed at peritoneoscopy and sulfur colloid distribution. Peritoneoscopy severity (scored as total peritoneoscopy score [PS]; range, 0-5) was assessed in 76 patients who also had QLSS. Multivariate equation were generated to estimate liver disease severity from the QLSS. These were then applied prospectively in 20 consecutive patients to validate these equations. In 76 patients, 62 were evaluated because of chronic liver disease (CLD) and included those with micronodular (20) and macronodular (20) cirrhosis with various degrees of severity (Child's A, 16; B, 29; C, 17). Multivariate analysis yielded a number of combinations of QLSS parameters that correlated with peritoneoscopic severity. These equations were used to estimate liver disease severity. Estimates of liver disease severity (estimated PS [EPS]) correlated well with the PS in these 76 patients (r = .9064; r2 = .8216; P < .0001). Adding histological fibrosis to the QLSS parameters yields an equation for estimating PS that was even more effective (r = .9462; r2 = .8953; P < .001). However, validation of multivariate equations requires confirmation of their value in a second population.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Superiority of the Child-Pugh classification to quantitative liver function tests for assessing prognosis of liver cirrhosis.

To evaluate the prognostic value of quantitative liver function tests in comparison with established prognostic variables, the data of 47 patients with liver cirrhosis were analysed. A total of 16 variables, comprising the galactose elimination capacity and the indocyanine green clearance, the Child-Pugh classification, and several clinical and biochemical variables were subjected to Kaplan-Meier life-table analysis and Cox proportional hazards regression analysis. As independent variables, poor prognosis was associated significantly with increasing Child-Pugh score (p less than 0.00001), whereas the galactose elimination capacity (p = 0.03) and the indocyanine green clearance (p less than 0.001) were less sensitive indicators. The regression analysis showed prognostic value in decreasing sequence for Child-Pugh classification, age, sex, history of upper GI haemorrhage, and alkaline phosphatase activity. The quantitative liver function tests evaluated in the present work have less prognostic value than routinely accessible variables.

Adult↗

Factors influencing postnatal liver function tests.

OBJECTIVE: To investigate liver function tests (LFTs) changes in the puerperium and the influence of specific obstetric events on these changes. DESIGN: A longitudinal observational study. SETTING: West Middlesex University Hospital, Twickenham. POPULATION: Ninety-four women with uncomplicated pregnancy who delivered at term. METHODS: Aspartate transaminase (AST), alanine transaminase (ALT), gamma glutamyl transferase (GGT), total bilirubin (Bilirubin) and alkaline phosphatase (ALP) were measured in early labour and on day 1, day 2, day 5 and day 10 postnatal. MAIN OUTCOME MEASURES: Peak enzyme concentration, time of peak enzyme concentration, the area under the curve for each enzyme and the rate of change of enzyme level from predelivery to peak concentration. RESULTS: All LFTs were affected by delivery (P < 0.001), increasing by 88% (0-500%) on day 2 or day 5 for AST, 147% (0-1140%) on day 5 for ALT and 63% (0-450%) on day 5 or day 10 for GGT. Multiple linear regression showed that caesarean section and opioid administration was associated with a faster rise in AST (P = 0.001, P = 0.033 respectively). The mean peak GGT concentration was 39% higher in women having caesarean section compared with vaginal delivery (P = 0.015). Univariate analysis showed that perineal trauma, use of Entonox, maternal age at delivery and breastfeeding also influenced LFT concentration significantly. CONCLUSION: Liver enzyme levels change significantly in the puerperium and are affected by common obstetric events, particularly caesarean section. This study aids clinical interpretation of postnatal LFTs in women recovering from liver-related illnesses, by facilitating the differentiation of physiological and pathological processes.

Adolescent↗