Use of LiMAx test leads to reduction in post-hepatectomy liver failure and related mortality
Retrospective analysis of 1170 patients shows improved outcomes of partial liver resections after the determination of the patient’s individual operative risk with the LiMAx test.
Post-operative liver failure is a severe complication after partial liver resections. Pre-existing hepatic dysfunction therefore remains a major concern when considering patients for liver resection. We need selection criteria that accurately identify patients in whom a surgical intervention can be safely performed. Humedics’ LiMAx test has been demonstrated to accurately and reliably assess liver function in both healthy subjects and patients with cirrhosis. It furthermore has been shown to be unaffected by age, gender or obesity.
In a retrospective study at the Department of General, Visceral and Transplantation Surgery, Charité – Universitätsmedizin Berlin, Campus Virchow Hospital, 1170 patients undergoing elective hepatectomy between January 2006 and December 2011 were analyzed. The aim of this study was to investigate the impact of the LiMAx test on patient selection and outcome. Propensity score matching was used to compare the effects on morbidity and mortality of the integration of the LiMAx algorithm into clinical practice.
Study results showed that even with more cirrhotic patients were selected to undergo liver surgery (6.9% in 2006 to 11.3% in 2011), the post-operative liver failure rate were dramatically decreased by 54.4% after the full implementation of LiMAx algorithm. Besides, the liver failure-related mortality dropped from 4% to 0.9% regardless of the increase in complex hepatectomy cases (including extended right hepatectomies and resections with concomitant biliary and/or vascular reconstruction).
The analysis of data for the propensity score-matched cohort suggests that the integration of the LiMAx algorithm was a major factor contributing to the improved outcomes. In conclusion, the integration of the LiMAx algorithm seems to have played an important role in optimizing risk assessment prior to hepatic surgery.
Investigator PD Dr. Martin Stockmann said: “We saw an increasing number of complex hepatectomies over the study period and at the same time a decline in postoperative liver failure and in particular a reduction in the number of postoperative liver failure related deaths. In my opinion the improved outcomes are associated with the integration of the LiMAx test in our routine work-up.”
A major strength of this study is that the analysis is based on all consecutive and unselected patients over 6 years that received partial hepatic resection of one or more segments in an attempt to overcome a potential selection bias.
Erwin de Buijzer, CEO of Humedics GmbH, stated: “We are very pleased that this retrospective study demonstrates once more the usefulness of our LiMAx test and its benefits for patients considered for liver surgery. For us, this study is especially interesting because the long study period covers the time of the introduction of the LiMAx test into the work routine at the Charité and clearly demonstrates the improvements in clinical outcomes over six years.”
The LiMAx test, together with the corresponding FLIP device and the diagnostic drug offers a clinically proven significant added value for patients with liver diseases and liver surgery.
HPB 2015, 17, 651–658
Based in Berlin, Germany, Humedics GmbH is specialised in rapid and accurate liver function measurement using LiMAx®, an innovative technology for analysing exhaled air. The LiMAx® test provides physicians with a method for quantitatively assessing an individual patient’s liver function capacity within minutes. This enables physicians to select treatment strategies and follow disease progression based on up-to-date knowledge of the functional health of the liver.
Current applications, which have already been published in prestigious medical journals, include liver function diagnosis before and after liver transplantation, surgical planning for liver surgery (such as assessing how much liver tissue can be removed without increasing the risk of acute liver failure), and assessment of liver diseases such as fibrosis and cirrhosis. At present, more than 20 studies regarding new indications are being conducted. These include diagnosing and staging of chronic liver diseases such as non-alcoholic steatohepatitis (NASH), as well as selecting, monitoring and managing different oncology treatment options.
These studies, initiated by researchers, have already provided evidence of further potential for the LiMAx® tests. The LiMAx® test is in routine clinical use at more than 30 leading university hospitals in Europe. So far, more than 20,000 LiMAx® tests have been performed. The LiMAx® test is commercially available in Germany, Austria and the UK.