Abstract
The timing of OLT is important because, on the one hand, a long and only modestly impaired survival with chronic liver disease should not be preempted by death due to an unsuccessful OLT nor should a possibly successful OLT be hindered by waiting until the candidate is critically ill. Standard “LFT's” are of little value In quantitating declining liver reserve. Sixteen infants and children awaiting OLT were studied 1-4 times during their course of illness using a set of “quantitative liver function tests” (OLPT's) comprising indocyanine green clearance (ICGC), galactose elimination (GEC) and 13C-aminopyrene breath test (ABT) to determine if they improve assessment of hepatic reserve. ICGC was deranged in all patients (t1/2=3.8-40 min, control=1.9-3.0), reflected cholestasis and/or portosystemic shunting and did not change with time. ABT was normal to severely deranged (11-2.4% 2hr excretion, control=8.5-12) and reflected hepatic reserve, but was difficult to perform and the results erratic. GEC was normal (t1/2=7.5 - 11.5 min, control=8-11.5) early in the course and fell linearly In each patient with progression to end-stage (22-28 min). Long GECs predicted inability to effect improved nutrition, important in OLT. We conclude that GEC improves assessment liver reserve before OLT.
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Whitington, P. QUANTITATIVE LIVER FUNCTION BEFORE ORTHOTOPIC LIVER TRANSPLANTATION (OLT). Pediatr Res 21 (Suppl 4), 281 (1987). https://doi.org/10.1203/00006450-198704010-00686
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DOI: https://doi.org/10.1203/00006450-198704010-00686