Monitoring liver function of patients undergoing transarterial chemoembolization (TACE) by a 13C breath test (LiMAx)

Barzakova, Emona; Bruners, Philipp (Thesis advisor); Berres, Marie-Luise (Thesis advisor)

Aachen (2021)
Dissertation / PhD Thesis

Dissertation, Rheinisch-Westfälische Technische Hochschule Aachen, 2021


Transarterial chemoembolization (TACE) is associated with the risk of deteriorating liver function, especially in patients with pre-existing liver damage. Current liver function tests may fail to accurately predict the functional reserve of the liver due to its versatility. Aim of this study was to investigate whether changes of liver function caused by TACE are associated with detectable changes of LiMAx values. LiMAx is a dynamic liver function breath-test based on metabolism of intravenously injected 13C-methacetin. Forty patients with primary or secondary liver cancer underwent TACE and LiMAx test on the day before, the day after and four weeks after TACE. LiMAx results were evaluated, referenced to liver volume (CT/MR-volumetry), correlated with the respective TACE volume (sub-segmental vs. segmental vs. lobar) and with established liver-function-tests as well as Child-Pugh- or ALBI-score.The individual LiMAx values were significantly reduced by 10% (p=0.01) on the day after TACE and fully recovered to baseline one month after treatment. Similar changes were observed regarding levels of bilirubin, transaminases, albumin, INR and creatinine. LiMAx did not correlate significantly with the volume of treated liver tissue, but did correlate with the baseline liver volume (<1200 ml vs. >1200 ml; p<0.01). No significant changes were observed in the Child-Pugh-score or ALBI-score. These results show that LiMAx is capable to detect changes of liver function, even modulations caused by super-selective TACE procedures. Accordingly, it could be used as a tool for patient selection and monitoring of transarterial therapy. In comparison, the Child-Pugh- and the ALBI-score did not reflect any of these changes. Some biochemical parameters also changed significantly after TACE, but tend to be less specific in providing sufficient information on actual cellular dysfunction.