HEPATIC LIDOCAINE METABOLISM AND COMPLICATIONS OF CIRRHOSIS - IMPLICATIONS FOR ASSESSING PATIENT PRIORITY FOR HEPATIC TRANSPLANTATION

The number of patients awaiting hepatic transplantation continues to e xceed organ donation. As a result, many liver transplant candidates wi ll develop life-threatening complications of their liver disease and n ot survive the pretransplant waiting period. Recent studies have demon strated that hepatic lidocaine metabolism into monoethylglycinexylidid e (MEG-X) can predict pretransplant survival. The present study was pe rformed to determine if MEG-X could also predict pretransplant complic ations and thereby be useful in stratifying persons being evaluated fo r hepatic transplantation. A total of 57 patients with biopsy-proven c irrhosis underwent MEG-X testing. Of 57 patients, 30 (53%) developed l ife-threatening complications of their liver disease-i.e., variceal bl eeding, grade II hepatic encephalopathy or worse, and spontaneous bact erial peritonitis. MEG-X values were greater in persons without compli cations of liver disease than in persons with complications (25.7+/-2. 9 versus 14.7+/-1.4 ng/ml, respectively). No patients with MEG-X great er than 30 ng/ml developed a major complication. No significant differ ence in any of the standard liver function tests existed between perso ns who developed complications and patients who did not. In this group of 57 patients, 4 (7%) died from complications of cirrhosis. Mean MEG -X for patients who died (5.5+/-1.6 ng/ml) was significantly less (P<0 .05) than observed for other patient groups. All patients who died had MEG-X values below 10 ng/ml. This suggests that MEG-X testing could b e an extremely useful test in the evaluation of patients for hepatic t ransplantation by identifying persons at increased risk for developing complications of chronic liver disease.