Safety and feasibility of liver maximum capacity assessment in patients undergoing transarterial chemoembolisation for hepatocellular carcinoma

Transarterial chemo-embolisation (TACE) is an established treatment for patients with hepatocellular carcinoma (HCC). As the majority have pre-existing liver disease, only patients with adequate liver function undergo TACE. Liver maximum capacity (LiMAx), using C¹³-Methacetin, is a novel method to assess liver function prior to major oncologic resections. We evaluated the safety and feasibility of using LiMAx to assess the changes in liver function with TACE and whether it could predict post-intervention complications. The prospective study was conducted between November 2021 and March 2023 on patients undergoing TACE for HCC at the University Hospitals Birmingham NHS Foundation Trust, UK. Patients underwent LiMAx assessment on three occasions: 1–2 weeks before, 4–6 weeks after, and 12–14 weeks following TACE. This was compared with well-established biochemical analyses. Thirty non-consecutive patients were included, with a median LiMAx value of 278 μg/kg/h (range 44–688) on visit 1, 30% had a LiMAx value < 140 μg/kg/h. There was no significant difference in the pre- and post-TACE LiMAX values (median difference − 6%). One patient presented with symptoms consistent with post-intervention liver decompensation with a pre-TACE LiMAx value of 95 μg/kg/h. LiMAx correlated with established biochemical scoring systems of liver functions such as Child-Pugh (r=-0.4055, p = 0.0262) and UKELD (r=-0.4166, p = 0.0220). LiMAx assessment is a safe, feasible and non-invasive measurement of liver function. Despite low LiMAx values in some patients, there was no incidence of post-procedural liver decompensation. Future research should aim at identifying patients with Child-Pugh B disease with adequate liver function, based on LiMAx assessments, who may benefit from TACE.