Open Access Open Badges Case report

A rapid and accurate new bedside test to assess maximal liver function: a case report

Sascha A Müller13*, Ignazio Tarantino1, Marcello Corazza1, Frank Pianka1, Jürgen Fornaro2, Ulrich Beutner1, Cornelia Lüthi1 and Bruno M Schmied1

Author Affiliations

1 Department of Surgery, Kantonsspital St.Gallen, St.Gallen, Switzerland

2 Institute of Radiology, Kantonsspital St.Gallen, St.Gallen, Switzerland

3 Rorschacherstrasse 95, St.Gallen, 9007, Switzerland

For all author emails, please log on.

Patient Safety in Surgery 2013, 7:11  doi:10.1186/1754-9493-7-11

Published: 25 April 2013



In liver surgery, appropriate preoperative evaluation and preparation of the patient is of cardinal importance. The up-to-date, preoperative prediction of residual liver function has thus far been limited. As post-hepatectomy liver failure is a major cause of mortality, a new and simple bedside test (LiMAx) has been developed to predict postoperative liver function in conjunction with preoperative volumetric analysis of the liver.

Case presentation

A 45-year-old patient presented with a cecal carcinoma and a large synchronous liver metastasis for major liver surgery. Liver function was determined by the LiMAx-test for the enzymatic capacity of cytochrome P450 1A2, which is ubiquitously and solely active in the liver. A solution of 2 mg/kg body weight 13C-labeled methacetin was injected as a bolus into an intravenous catheter and, thereafter, was metabolized into acetaminophen and 13CO2 and pulmonarily exhaled. The analysis of the 13CO2/12CO2 ratio was performed using online breath sampling over a period of maximally 60 minutes. Based on this test, a value of more than 315 μg/kg/h represents normal liver function. A laparoscopic right hemihepatectomy was planned during virtual resection with a residual liver volume of 48% and a preoperative anticipated residual LiMAx of 301 μg/kg/h. After successful resection, the initial postoperative LiMAx value was 316 μg/kg/h, indicating good liver function and a correct prediction of the outcome.


In the presented patient, residual liver function could be accurately predicted preoperatively using a combination of the new LiMax test with CT-volumetry. This test might significantly improve preoperative evaluation and postoperative outcomes in liver surgery.

Liver function; Liver volumetry; Liver resection; Liver function measurement; LiMAx