METABOLIC LIVER FUNCTION TEST TO PREDICT MORBIDITY/MORTALITY IN LIVER CIRRHOSIS

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A study to determine the best time to perform a liver transplant. Liver transplantation is the best therapy for patients with cirrhosis and end-stage liver disease. This procedure has a success rate of 80% or better over the past several years. There is an active waiting list for liver transplant of over 4500 people. The length of the waiting period increases as the list increases. There are usually only 3500 donors annually and about 1000 people will develop major complications and die while waiting for a donor liver. A test is needed that can more accurately determine the patient's risk of complications, thus, the list can be prioritized. Approximately 750 adults who are referred to this institution for liver transplants will be studied. The anticipated average age of the subjects is 50 years. Patients will be monitored at monthly intervals for symptoms of cirrhosis. The patients will receive the usual liver-function tests and new tests to prioritize them for transplant. The ability to break down and/or excrete certain medications is a way to more accurately measure how well the liver functions. Two such tests are a) the ability to break down lidocaine (a local anesthetic) and b) the ability to excrete indocyanine green (an inactive dye). Several studies have shown that these tests can be used to predict how well a liver will perform following transplantation and how well a patient with liver disease will do over a period of one year. Blood samples will be obtained on a monthly basis. There will be outpatient visits to the General Clinical Research Center where metabolic liver function tests, blood tests, pre-transplant testing, and vital sign assessment will be done. Continuous nutritional assessments will be done.