Monitoring liver function of patients undergoing transarterial chemoembolization (TACE) by a 13C breath test (LiMAx)

Transarterial chemoembolization (TACE) is associated with the risk of deteriorating liver function, especially in patients with pre-existing liver damage. Current liver function tests may fail to accurately predict the functional reserve of the liver due to its versatility. Aim of this study was to investigate whether changes of liver function caused by TACE are associated with detectable changes of LiMAx values. LiMAx is a dynamic liver function breath-test based on metabolism of intravenously injected 13C-methacetin. Forty patients with primary or secondary liver cancer underwent TACE and LiMAx test on the day before, the day after and four weeks after TACE. LiMAx results were evaluated, referenced to liver volume (CT/MR-volumetry), correlated with the respective TACE volume (sub-segmental vs. segmental vs. lobar) and with established liver-function-tests as well as Child-Pugh- or ALBI-score.The individual LiMAx values were significantly reduced by 10% (p=0.01) on the day after TACE and fully recovered to baseline one month after treatment. Similar changes were observed regarding levels of bilirubin, transaminases, albumin, INR and creatinine. LiMAx did not correlate significantly with the volume of treated liver tissue, but did correlate with the baseline liver volume (1200 ml; p