Applications of the LiMAx® test
The LiMAx test can be applied in liver surgery, liver transplantation, hepatology, and oncology.
Liver surgery: Certainty in surgical planning by predicting post-operative liver capacity
About 80 % of the liver can be resected in a healthy patient. The critical parameter for survival of the patient is his or her residual liver function after surgery, which is not the same as the remaining volume of the liver. Therefore, if the patient has pre-existing liver damage, for example cirrhosis, liver fibrosis, hepatitis or ongoing chemotherapy, there is an increased risk of post-operative liver failure even after smaller resections.
The LiMAx test unveils the liver function capacity. This allows for better risk assessment in liver surgery through precise risk prediction of liver failure and residual post-operative liver function. Data from clinical trials show that implementation of the LiMAx test in the hospital reduces mortality caused by post-operative liver failure. Therefore, knowledge of the LiMAx test result provides certainty for the surgeon and safety for the patient.
Prediction of postoperative liver function capacity via LiMAx test
Figure based on:
Stockmann, Martin, et al. The LiMAx test: a new liver function test for predicting postoperative outcome in liver surgery. Hpb 12.2 (2010): 139-146.
Post hepatectomy patient management with the LiMAx® protocol for enhanced recovery
Applying the LiMAx protocol reduces the incidence of major complications and facilitates recovery of patients undergoing hepatectomy, leading to fewer days at intensive care and shorter overall length of hospitalization. At the same time, costs can be reduced.
The LiMAx test is easy to integrate into clinical routines (see figure 2). Adding the LiMAx test before and after hepatectomy improves treatment outcome and helps to identify patients with low risk of postoperative complications who can be safely managed without intensive care (figure 3).
Individualized planning of liver surgery for optimized postoperative patient management
Jara M et al., Reductions in post-hepatectomy liver failure and related mortality after implementation of the LiMAx algorithm in preoperative work-up: a single-centre analysis of 1170 hepatectomies of one or more segments, Hpb 17(7) (2015):651-658.
Stockmann M et al., The LiMAx test: a new liver function test for predicting postoperative outcome in liver surgery. Hpb 12.2 (2010):139-146.
LiMAx algorithm for preoperative planning dramatically improved patient outcome after liver surgery
Liver transplantation: Preventing delayed graft function
In liver transplantation, it is important to assess both the condition of the donor‘s liver and the urgency of the need for transplantation in the recipient – the LiMAx test can answer both these questions by determining the real-time liver function capacity of the donor and the recipient. This makes it the ideal test for pre-operative assessment and post-operative follow-up, helping to prevent delayed graft function.
Lock JF et al., Early Diagnosis of Primary Nonfunction and Indication for Reoperation After Liver Transplantation, Liver Transpl (2010) 16:172-180
Stockmann M et al., How to define initial poor graft function after liver transplantation? - a new functional definition by the LiMAx test, Transpl Int (2010) 23(10):1023-32
Hepatology: Assessing and grading of severity of liver disease
Applying the LiMAx test in hepatology has the potential to change the landscape in liver disease treatment and management.
The test has been applied in studies to examine the variation of liver function capacity in patients with liver disorders, including cirrhosis, alcoholic liver disease, viral hepatitis, or non-alcoholic fatty liver disease (NAFLD). It allows a clear stratification of disease severity in cirrhotic patients, which helps to optimize treatment of these patients. The LiMAx test has also been applied in patients receiving bariatric surgery to evaluate the improvement of liver function capacity and treatment efficacy.
LiMAx test can therefore accurately and non-invasively diagnose and classify cirrhosis patients, avoiding liver biopsy in most of the patients. Moreover, a functional classification can be more effective than conventional histological grading, improving clinical management and patient outcome.
Stockmann, M et al.,1073 Accurate Diagnosis and grading of cirrhosis using the new LiMAx test, Journal of Hepatology 56 (2012): S422.
LiMAx for stratification of disease severity in cirrhotic patients
Oncology: Supporting neoadjuvant and adjuvant chemotherapy decision-making in colorectal cancer
Chemotherapy-induced liver injury is a well-recognized issue following neoadjuvant therapy of colorectal liver metastases, and it contributes to post-operative morbidity and mortality. While combining chemotherapy with subsequent partial liver resection for liver metastases has shown good outcomes in colorectal cancer patients, working out the optimum length of time between cessation of chemotherapy and liver resection is challenging. Because liver function capacity is key for decision-making in partial liver resection after chemotherapy, the LiMAx test has potential to improve the assessment of patients scheduled for surgery.
Clinical trials using the LiMAx test in colorectal cancer patients with liver metastases have shown that the toxicity of oxaliplatin-based anti-cancer regimens significantly reduces liver function after chemotherapy. The study results also showed that liver function recovery after cessation of chemotherapy is variable. Using the LiMAx tests allows physicians to downstage inoperable colorectal metastatic disease using neoadjuvant chemotherapeutical regimens, creating a resectable condition where potentially curative treatment can be offered.
Jara, Maximilian, et al. Effects of oxaliplatin-based chemotherapy on liver function – an analysis of impact and functional recovery using the LiMAx test. Langenbeck's Archives of Surgery 401.1 (2016): 33-41.
Bednarsch, Jan, et al. Noninvasive diagnosis of chemotherapy induced liver injury by LiMAx test–two case reports and a review of the literature. BMC research notes 8.1 (2015): 1.