VALUE OF AN EXTENDED MONOETHYLGLYCINEXYLIDIDE FORMATION TEST AND OTHER DYNAMIC LIVER-FUNCTION TESTS IN LIVER-TRANSPLANT DONORS

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 transplanta tion, but some groups have demonstrated a low test efficacy. We, there fore, investigated the value of an extended MEGX formation test and th e value of other dynamic liver function tests, in selecting suitable h uman donor livers. In 51 human multi-organ donors, we measured elimina tion of galactose, indocyanine green, and lidocaine, as well as format ion of MEGX, at 15, 30, and 60 min after administration of the test su bstances. In the early postoperative period, the function of the trans planted liver was then classified as good or poor, as defined by a pro thrombin time above or below 65% by day 4 and fibrinogen concentration above or below 300 mg/dl by day 7. Donor characteristics and preserva tion modalities were very similar between the two groups. Galactose, i ndocyanine green, and lidocaine metabolism failed to predict good or p oor graft function in the early postoperative period. MEGX serum conce ntrations, however, were significantly higher in the group of donors w hose organs functioned well in the recipients, as compared with donors whose organs functioned poorly in the recipients. This was true for M EGX concentrations at 15 min (117+/-9 vs. 90+/-9 ng/ml; P=0.03), 30 mi n (108+/-8 vs. 86+/-8 ng/ml; P=0.04), and 60 min (100+/-6 vs. 73+/-5 n g/ml; P=0.006). Extending the MEGX formation test from 15 to 60 min im proved test efficacy. Maximal MEGX concentration in 9 or up to 12 cons ecutive blood samples, drawn between 3 and 120 min after lidocaine inf usion, 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 fun ction differed significantly with respect to their MEGX serum concentr ations, and although efficacy of the MEGX test was improved by extendi ng the test from 15 to 60 min, the overlap in individual MEGX serum co ncentrations was still so wide that it is virtually impossible to pred ict early graft function only on the basis of the MEGX test in the don or. Therefore, the MEGX test, although of potential scientific interes t, does not predict early graft function with an accuracy necessary fo r clinical use.