Reliable assessment of liver function using LiMAx

J Surg Res. 2015 Jan;193(1):184-9. doi: 10.1016/j.jss.2014.07.041. Epub 2014 Jul 24.


Background: (13)C-liver function breath tests can facilitate the assessment of hepatic function in-vivo and may help surgeons to identify candidates for safe liver surgery. However, their acceptance into clinical practice is dependent on evaluation of technical efficacy and repeatability. The aims of this study were to evaluate the within-subject repeatability of the LiMAx (maximum liver function capacity) test in healthy individuals and in surgical patients to determine liver function in the perioperative workup.

Material and methods: The LiMAx test, which is based on intravenous injection of (13)C-methacetin at a dosage of 2 mg/kg body weight was performed in eighty-six healthy subjects to determine a reference range. Twenty-four subjects underwent repeat LiMAx testing the following day to assess within-subject repeatability. Twenty-one patients undergoing elective extra-abdominal surgery under general anesthesia (GA group) received pre- and post-operative examinations.

Results: The normal range of LiMAx was found to be 430 ± 86 μg/kg/h and revealed a one-sided cut-off value of 315 μg/kg/h. The intraclass correlation coefficient of the repeat LiMAx tests was 0.85 (95% confidence interval 0.69-0.93) in the control group and 0.81 (95% confidence interval 0.60-0.92) in the group of patients with GA.

Conclusions: The LiMAx test shows excellent reproducibility in subjects with normal liver function. GA has no effect on test results.

Keywords: Intra-individual repeatability; Liver function; Liver function test; Surgery; Within-subject repeatability.

Publication types

  • Clinical Trial
  • Comparative Study
  • Validation Study

MeSH terms

  • Abdomen / surgery
  • Acetamides*
  • Adult
  • Breath Tests / methods
  • Carbon Dioxide / metabolism
  • Carbon Isotopes
  • Elective Surgical Procedures
  • Female
  • Healthy Volunteers
  • Humans
  • Liver Function Tests / methods*
  • Liver Function Tests / standards*
  • Male
  • Models, Biological
  • Preoperative Care / methods
  • Preoperative Care / standards
  • Reference Values
  • Reproducibility of Results
  • Young Adult


  • Acetamides
  • Carbon Isotopes
  • methacetin
  • Carbon Dioxide