Prognostic Value of the Monoethylglycinexylidide (MEGX)-Test prior to Liver Resection

Background/Aims: The critical issue before major hepatic resection is to evaluate and detect patients with a potentially increased risk of hepatic failure. In this study the prognostic value of the monoethylglycinexylidide (MEGX)- liver function test was evaluated with regards to clinical course and survival after partial liver resection. Methodology: Between 1995 and 2000 a total of 55 patients (29 male, 26 female) underwent a partial liver resection at the Georg-August University of Gottingen. Forty-two patients were treated for malignant, and 13 for benign, disease. MEGX-testing was performed 15 and 30 minutes after a single-dose of 1mg/kg BW Lidocaine i.v. was applied. Results: MEGX-test results after 30 minutes had significant influence on hospital mortality. Patients who died during the hospital stay showed median MEGX-30 minutes results of 32μg/L in (4-107μg/L) in comparison to the surviving patients with a median 68μg/L (16-176μg/L) (p=0.026). Furthermore, patients with MEGX scaled categories of 3 and 4 had a significantly lower surivial at 150 days (p=0.008) and overall (p=0.0002). There was an indirect impact of MEGX on hospital stay, costs and mortality reflecting high fluid loss: patients with lower loss of fluid over drainages had a significantly lower mortality at 150 days (p=0.00046) and overall (p=0.00008), than did patients with higher fluid loss. Low MEGX-values significantly influenced long hospital stay (p=0.00001) and high costs (p=0.00001). Pathologic MEGX in combination with increased age, increased BMI and extensive surgical procedures including resection of over 50% volume of the liver had a significant influence on complications (p =0.015). Conclusion: The preoperative MEGX-test, especially the 30 minutes value, is a useful medium to estimate the liver reserve in non-cirrhotic patients prior to liver resection. In combination with the resection volume it may be very useful to identify patients with a high risk of developing a postoperative liver failure.