Evaluation of Liver Function

  • Vanessa Cowan


Conventional liver function tests are insensitive and not able to detect discreet injury that affect mostly oxidative pathway of liver metabolism. Assesment of liver function is important for risk estimation prior to liver resections and transplants. This chapter will review limitations of conventional liver function tests and discuss the use of more sensitive, dynamic liver functions tests.

Dynamic (Quantitative) Liver Function Tests

Conventional liver function test measure multiple aspects of liver function and injury. Transaminases such as aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are intracellular enzymes that are released during hepatocyte injury and reflect the degree of liver injury; for example after ischemia-reperfusion injury. Metabolic function is frequently assessed by measuring albumin and protein levels. Biliary obstruction or injury causes a release of the enzyme alkaline phosphatase that lines the epithelium of the bile...


Liver function test Bilirubin Indocyanain green Dynamic liver function tests Monoethylgycinexylidide test Sorbitol clearance 


  1. 1.
    Wagener G. Assessment of hepatic function, operative candidacy, and medical management after liver resection in the patient with underlying liver disease. Semin Liver Dis. 2013;33(3):204–12.CrossRefGoogle Scholar
  2. 2.
    Levesque E, Martine E, Dudau D, Lim C, et al. Current use and perspective of indocyanine green clearance in liver diseases. Anaesth Crit Care Pain Med. 2016;35:49–57.CrossRefGoogle Scholar
  3. 3.
    Vos JJ, Wietash JKG, Absalom AR, et al. Green light for liver function monitoring using indocyanine green? An overview of current clinical applications. Anaesthesia. 2014;69:1364–76.CrossRefGoogle Scholar
  4. 4.
    Halle BM, Poulsen TD, Pedersen HP. Indocyanine green plasma disappearance rate as dynamic liver function test in critically ill patients. Acta Anaesthesiol Scand. 2014;58:1214–9.CrossRefGoogle Scholar
  5. 5.
    Kortgen A, Paxian M, Werth M, Rechnagel P, et al. Prospective assessment of hepatic function and mechanisms of dysfunction in the critically ill. Shock. 2009;32(4):358–65.CrossRefGoogle Scholar
  6. 6.
    Sakka S, Reinhart K, Meier-Hellmann A. Prognostic value of the indocyanine green plasma disappearance rate in critically ill patients. Chest. 2002;122(5):1715–20.CrossRefGoogle Scholar
  7. 7.
    Klinzing S, Brandi G, Stehberger P, et al. The combination of MELD score and ICG liver testing predicts length of stay in the ICU and hospital mortality in liver transplant recipients. BMC Anesthesiol. 2014;14:103–9.CrossRefPubMedCentralGoogle Scholar
  8. 8.
    Merle U, Sieg O, Stremmel W, et al. Sensitivity and specificity of plasma disappearance rate of indocyanine green as a prognostic indicator in acute liver failure. BMC Gastroenterol. 2009;9:91–7.CrossRefPubMedCentralGoogle Scholar
  9. 9.
    Mizuguchi T, Kawamoto M, Meguro M, et al. Preoperative liver function assessments to estimate the prognosis and safety of liver resections. Surg Today. 2014;44:1–10.CrossRefPubMedCentralGoogle Scholar
  10. 10.
    De Gasperi A, Mazza E, Prosperi M. Indocyanine green kinetics to assess liver function: ready for a clinical dynamic assessment in major liver surgery? World J Hepatol. 2016;8(7):355–67.CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Imamura H, Sano K, Sugawara Y, et al. Assessment of hepatic reserve for indication of hepatic resection: decision tree incorporating indocyanine green test. J Hepato-Biliary-Pancreat Surg. 2005;12:16–22.CrossRefGoogle Scholar
  12. 12.
    Imamura H, Seyama Y, Kokudo N, Maema A, et al. One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg. 2003;138:1198–206.CrossRefGoogle Scholar
  13. 13.
    Zipprich A, Kuss O, Rogowski S, Kleber G, et al. Incorporating indocyanin green clearance into the model for end stage liver disease (MELD-ICG) improves prognostic accuracy in intermediate to advanced cirrhosis. Gut. 2010;59:963–8.CrossRefPubMedCentralGoogle Scholar
  14. 14.
    Olmedilla L, Lisbona CJ, Perez-Pena JM, Lopez-Baena JA, et al. Early measurement of indocyanine green clearance accurately predicts short-term outcomes after liver transplantation. Transplantation. 2016;100(3):613–20.CrossRefPubMedCentralGoogle Scholar
  15. 15.
    Levesque E, Saliba F, Benhamida S, Ichai P, et al. Plasma disappearance rate of indocyanine green: a tool to evaluate early graft outcome after liver transplantation. Liver Transpl. 2009;15:1358–64.CrossRefGoogle Scholar
  16. 16.
    Olmedilla L, Perez-Pena JM, Ripoll C, Garutti I, et al. Early noninvasive measurement of the indocyanine green plasma disappearance rate accurately predicts early graft dysfunction and mortality after deceased donor liver transplantation. Liver Transpl. 2009;15:1247–53.CrossRefPubMedCentralGoogle Scholar
  17. 17.
    Levesque E, Hoti E, Azoulay D, Adam R, et al. Non-invasive ICG-clearance: a useful tool for the management of hepatic artery thrombosis following liver transplantation. Clin Transpl. 2011;25:297–301.CrossRefGoogle Scholar
  18. 18.
    Du A, Wei Y, Chen K, Chen X, et al. Risk factor and criteria predicting early graft loss after adult-to-adult living donor liver transplantation. J Surg Res. 2014;187:673–82.CrossRefGoogle Scholar
  19. 19.
    Hori T, Lida T, Yagi S, Taniguchi K, et al. KICG value, a reliable real-time estimator of graft function, accurately predicts outcomes in adult living-donor liver transplantation. Liver Transpl. 2006;12:605–13.CrossRefGoogle Scholar
  20. 20.
    Oellerich M, Armstrong VW. The MEGX test: a tool for the real-time assessment of hepatic function. Ther Drug Monit. 2001;23:81–92.CrossRefGoogle Scholar
  21. 21.
    Hoekstra LT, de Graaf W, Nibourg GA, Heger M, et al. Physiological and biochemical basis of clinical liver function tests: a review. Ann Surg. 2013;257(1):27–36.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Transplant InstituteBeth Israel Deaconess Medical CenterBostonUSA

Personalised recommendations