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<p>Transarterial chemo-embolisation (TACE) is an established treatment for patients with hepatocellular carcinoma (HCC). As the majority have pre-existing liver disease, only patients with adequate liver function undergo TACE. Liver maximum capacity (LiMAx), using C<sup>13</sup>-Methacetin, is a novel method to assess liver function prior to major oncologic resections. We evaluated the safety and feasibility of using LiMAx to assess the changes in liver function with TACE and whether it could predict post-intervention complications. The prospective study was conducted between November 2021 and March 2023 on patients undergoing TACE for HCC at the University Hospitals Birmingham NHS Foundation Trust, UK. Patients underwent LiMAx assessment on three occasions: 1–2 weeks before, 4–6 weeks after, and 12–14 weeks following TACE. This was compared with well-established biochemical analyses. Thirty non-consecutive patients were included, with a median LiMAx value of 278<InlineEquation ID="IEq1"> <EquationSource Format="TEX">\(\:\:\mu\:\)</EquationSource> </InlineEquation>g/kg/h (range 44–688) on visit 1, 30% had a LiMAx value &lt; 140 <InlineEquation ID="IEq2"> <EquationSource Format="TEX">\(\:\mu\:\)</EquationSource> </InlineEquation>g/kg/h. There was no significant difference in the pre- and post-TACE LiMAX values (median difference − 6%). One patient presented with symptoms consistent with post-intervention liver decompensation with a pre-TACE LiMAx value of 95 <InlineEquation ID="IEq3"> <EquationSource Format="TEX">\(\:\mu\:\)</EquationSource> </InlineEquation>g/kg/h. LiMAx correlated with established biochemical scoring systems of liver functions such as Child-Pugh (<i>r</i>=-0.4055, <i>p</i> = 0.0262) and UKELD (<i>r</i>=-0.4166, <i>p</i> = 0.0220). LiMAx assessment is a safe, feasible and non-invasive measurement of liver function. Despite low LiMAx values in some patients, there was no incidence of post-procedural liver decompensation. Future research should aim at identifying patients with Child-Pugh B disease with adequate liver function, based on LiMAx assessments, who may benefit from TACE.</p>

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Safety and feasibility of liver maximum capacity assessment in patients undergoing transarterial chemoembolisation for hepatocellular carcinoma

  • 期刊论文

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  • 发表日期：

    2026年2月10日

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  • George Clarke,
  • Sofi Dhanaraj,
  • Diana Hull,
  • Michelle Panton,
  • Hynek Mergental,
  • Simon C. Afford,
  • Shishir Shetty,
  • Salil Karkhanis,
  • Homoyon Mehrzad,
  • Yuk Ting Ma,
  • Pankaj Punia,
  • Tahir Shah,
  • Bobby V. M. Dasari

摘要

Transarterial chemo-embolisation (TACE) is an established treatment for patients with hepatocellular carcinoma (HCC). As the majority have pre-existing liver disease, only patients with adequate liver function undergo TACE. Liver maximum capacity (LiMAx), using C13-Methacetin, is a novel method to assess liver function prior to major oncologic resections. We evaluated the safety and feasibility of using LiMAx to assess the changes in liver function with TACE and whether it could predict post-intervention complications. The prospective study was conducted between November 2021 and March 2023 on patients undergoing TACE for HCC at the University Hospitals Birmingham NHS Foundation Trust, UK. Patients underwent LiMAx assessment on three occasions: 1–2 weeks before, 4–6 weeks after, and 12–14 weeks following TACE. This was compared with well-established biochemical analyses. Thirty non-consecutive patients were included, with a median LiMAx value of 278 \(\:\:\mu\:\) g/kg/h (range 44–688) on visit 1, 30% had a LiMAx value < 140 \(\:\mu\:\) g/kg/h. There was no significant difference in the pre- and post-TACE LiMAX values (median difference − 6%). One patient presented with symptoms consistent with post-intervention liver decompensation with a pre-TACE LiMAx value of 95 \(\:\mu\:\) g/kg/h. LiMAx correlated with established biochemical scoring systems of liver functions such as Child-Pugh (r=-0.4055, p = 0.0262) and UKELD (r=-0.4166, p = 0.0220). LiMAx assessment is a safe, feasible and non-invasive measurement of liver function. Despite low LiMAx values in some patients, there was no incidence of post-procedural liver decompensation. Future research should aim at identifying patients with Child-Pugh B disease with adequate liver function, based on LiMAx assessments, who may benefit from TACE.