Zotz R B, von Schönfeld J, Erhard J, Breuer N, Lange R, Beste M, Goebell H, Eigler F W
Department of Gastroenterology, Medical Clinic, Essen, Germany.
Transplantation. 1997 Feb 27;63(4):538-41. doi: 10.1097/00007890-199702270-00009.
Measuring monoethylglycinexylidide (MEGX) formation after intravenous administration of lidocaine in potential organ donors (MEGX test) has been advocated as a useful test to select donor livers for transplantation, but some groups have demonstrated a low test efficacy. We, therefore, investigated the value of an extended MEGX formation test and the value of other dynamic liver function tests, in selecting suitable human donor livers. In 51 human multi-organ donors, we measured elimination of galactose, indocyanine green, and lidocaine, as well as formation of MEGX, at 15, 30, and 60 min after administration of the test substances. In the early postoperative period, the function of the transplanted liver was then classified as good or poor, as defined by a prothrombin time above or below 65% by day 4 and fibrinogen concentration above or below 300 mg/dl by day 7. Donor characteristics and preservation modalities were very similar between the two groups. Galactose, indocyanine green, and lidocaine metabolism failed to predict good or poor graft function in the early postoperative period. MEGX serum concentrations, however, were significantly higher in the group of donors whose organs functioned well in the recipients, as compared with donors whose organs functioned poorly in the recipients. This was true for MEGX concentrations at 15 min (117+/-9 vs. 90+/-9 ng/ml; P=0.03), 30 min (108+/-8 vs. 86+/-8 ng/ml; P=0.04), and 60 min (100+/-6 vs. 73+/-5 ng/ml; P=0.006). Extending the MEGX formation test from 15 to 60 min improved test efficacy. Maximal MEGX concentration in 9 or up to 12 consecutive blood samples, drawn between 3 and 120 min after lidocaine infusion, was also significantly higher in donors whose organs functioned well, than in donors whose organs functioned poorly (129+/-10 vs. 101+/-10 ng/ml; P=0.03). Although the groups with good and poor organ function differed significantly with respect to their MEGX serum concentrations, and although efficacy of the MEGX test was improved by extending the test from 15 to 60 min, the overlap in individual MEGX serum concentrations was still so wide that it is virtually impossible to predict early graft function only on the basis of the MEGX test in the donor. Therefore, the MEGX test, although of potential scientific interest, does not predict early graft function with an accuracy necessary for clinical use.
静脉注射利多卡因后测量潜在器官供体中的单乙基甘氨酰二甲苯胺（MEGX）生成情况（MEGX试验），一直被倡导作为一种选择供肝进行移植的有用检测方法，但一些研究团队已证明该检测方法的效能较低。因此，我们研究了扩展MEGX生成试验的价值以及其他动态肝功能检测方法在选择合适的人类供肝方面的价值。在51例人类多器官供体中，我们在给予检测物质后15、30和60分钟测量了半乳糖、吲哚菁绿和利多卡因的清除情况以及MEGX的生成情况。在术后早期，根据术后第4天凝血酶原时间高于或低于65%以及术后第7天纤维蛋白原浓度高于或低于300mg/dl，将移植肝的功能分为良好或不良。两组之间的供体特征和保存方式非常相似。半乳糖、吲哚菁绿和利多卡因代谢情况无法预测术后早期移植肝的功能良好或不良。然而，与器官在受者体内功能不良的供体相比，器官在受者体内功能良好的供体组中MEGX血清浓度显著更高。在15分钟时MEGX浓度情况如此（117±9 vs. 90±9 ng/ml；P = 0.03），30分钟时（108±8 vs. 86±8 ng/ml；P = 0.04），以及60分钟时（100±6 vs. 73±5 ng/ml；P = 0.006）。将MEGX生成试验从15分钟延长至60分钟可提高检测效能。在利多卡因输注后3至120分钟采集的9份或多达12份连续血样中的最大MEGX浓度，器官功能良好的供体也显著高于器官功能不良的供体（129±10 vs. 101±10 ng/ml；P = 0.03）。尽管器官功能良好和不良的组在MEGX血清浓度方面存在显著差异，并且尽管将MEGX试验从15分钟延长至60分钟可提高其效能，但个体MEGX血清浓度的重叠范围仍然很大，以至于仅根据供体的MEGX试验几乎不可能预测早期移植肝功能。因此，MEGX试验尽管具有潜在的科学意义，但无法以临床应用所需的准确性预测早期移植肝功能。
