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

GND
1051742587
Affiliation
Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Rashidi-Alavijeh, Jassin;
GND
131647075
ORCID
0000-0002-2823-6774
LSF
12946
Affiliation
Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Kahraman, Alisan;
GND
1071577948
ORCID
0000-0001-5734-8006
LSF
14605
Affiliation
Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Gerken, Guido;
GND
143669273
ORCID
0000-0001-5869-7929
LSF
52857
Affiliation
Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Theysohn, Jens M.;
GND
1072630575
ORCID
0000-0002-1474-7733
LSF
60871
Affiliation
Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Willuweit, Katharina;
GND
140343342
Affiliation
Department of General-, Visceral- and Transplantation Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Hoyer, Dieter P.;
GND
1266672311
ORCID
0000-0001-9983-5136
LSF
60126
Affiliation
Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Lange, Christian M.;
GND
137554397
ORCID
0000-0003-3394-5492
LSF
60128
Affiliation
St. Nikolaus-Stiftshospital, Andernach, Germany
Buechter, Matthias
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.

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