Bednarsch Jan, Jara Maximilian, Lock Johan Friso, Malinowski Maciej, Pratschke Johann, Stockmann Martin
Department of General, Visceral and Transplantation Surgery, Charité University Hospital, Augustenburger Platz 1, 13353, Berlin, Germany.
BMC Res Notes. 2015 Mar 26;8:99. doi: 10.1186/s13104-015-1055-6.
Chemotherapy-induced liver injury is a well-known phenomenon after neoadjuvant therapy of liver metastasis and contributes to postoperative morbidity and mortality. Still there is no suitable test available to reliably determine functional impairment and hepatic regeneration after chemotherapy.
We report two cases of caucasian patients who underwent repeated liver function assessments using LiMAx (maximum liver function capacity), Indocyanine plasma disappearance rate and biochemical liver function parameters in the course of adjuvant oxaliplatin-based chemotherapy. Both patients yielded a decrease from their initial liver function determined by LiMAx. Liver regeneration assessed functional recovery within 4 weeks in case of mild functional impairment after cessation of chemotherapy or within 8 weeks in case of major functional deterioration. Indocyanine plasma disappearance rate and biochemical parameters remained stable or without a clear trend in case of minor functional impairment. This is the first report using a dynamic liver function test to evaluate the impact and recovery from chemotherapy associated liver injury.
The LiMAx test might be a sensitive tool to diagnose mild functional impairment after chemotherapy when standard liver function tests have remained within normal ranges and might be capable to assess the course of regeneration after chemotherapy. This could be useful to optimize individual chemotherapy-free interval before liver surgery can be carried out safely.
化疗引起的肝损伤是肝转移新辅助治疗后一种众所周知的现象，会导致术后发病率和死亡率升高。然而，目前尚无合适的检测方法能够可靠地确定化疗后的肝功能损害和肝再生情况。
我们报告了两例白人患者，在基于奥沙利铂的辅助化疗过程中，使用LiMAx（最大肝功能容量）、吲哚菁绿血浆消失率和生化肝功能参数对其进行了多次肝功能评估。两名患者的LiMAx测定的初始肝功能均有所下降。化疗停止后，若肝功能轻度受损，肝脏再生在4周内评估功能恢复；若肝功能严重恶化，则在8周内评估功能恢复。吲哚菁绿血浆消失率和生化参数在轻度功能损害时保持稳定或无明显趋势。这是首篇使用动态肝功能检测来评估化疗相关性肝损伤的影响及恢复情况的报告。
当标准肝功能检测仍在正常范围内时，LiMAx检测可能是诊断化疗后轻度功能损害的敏感工具，并且可能有能力评估化疗后的肝再生过程。这对于在安全进行肝脏手术前优化个体无化疗间期可能是有用的。
