Skip to main content
Log in

A Single Centre Prospective Study of Liver Function Tests in Post Liver Transplant Patients

  • Original Article
  • Published:
Indian Journal of Clinical Biochemistry Aims and scope Submit manuscript

Abstract

Liver transplantation means surgical replacement of a diseased liver with a healthy liver. The survival rate used to be 30 % after 1 year and LTx was considered to be the last procedure when all medical or surgical intervention failed. Advances in donor organ preservation, surgical techniques, patient selection, immunosuppressive regimens and treatments for opportunistic infections all have contributed to substantially improve the survival rates. Despite substantial technological, medical and surgical advances, liver transplantation remains a complex procedure that is accompanied by significant morbidity and mortality. The post-operative outcome of each patient varies greatly depending on the patient’s pre- operative state, quality of the donated organ and the complexity of the surgery. Complications occur both immediately post transplant and in the long term. Most of the problems can be satisfactorily assessed with a panel of routine LFTs results of which are generated quickly, cheaply on the analyzer which operates 24 h. Liver Function Test identifies the presence of problem but not problem itself. Abnormal results can be meaningful only when used with clinical data, radiological findings. The study includes 75 post LTx patients in three groups adults (non ACR), Pediatrics and ACR. All recipients were on immunosuppressive therapy (tacrolimus, mycophenolate and methylprednisolone), antiviral (ganciclovir), antiprotozoal, antibacterial and antifungal (fluconazole). 5 mL of blood was drawn in plain vacutainer from the post LTx patients every day for 15 days and LFT and GGT was done. Routinely performed liver function tests correlates well with clinical complications involving liver in the transplant patients. Instead of daily testing, may be alternate day analysis of LFT should be sufficient for effective monitoring of patients. The total protein and albumin and the transaminases offer little help in monitoring LFT post LTx. The elevated levels of serum GGT and ALP may be related to chronic immune damage to the transplanted liver. Serum GGT and ALP can be used as early markers for diagnosing biliary complications and can be used to asses adequacy of endoscopic treatment in the group of patients presenting early. Thus, most of the problems can be satisfactorily assed with a panel of routine LFTs generated quickly, cheaply on analyzer which operates 24 h each day. However, it must be emphasized that LFTs may identify the presence of problems but not the problem itself and the abnormal results are meaningful only when correlated with other clinical information.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Starzl TE, Marchioro TL, VonKaulla KN, Hermann G, Brittain RS, Waddell WR. Homotransplantations of the liver in humans. Surg Gynecol Obstet. 1963;117:659–79.

    PubMed  CAS  Google Scholar 

  2. Brown RS Jr., Loke JR. Gastroenterology and hepatology. In: Current medicine. vol I, the Liver ed. Philadelphia: Willis C Maddrey Publication; 1994. p 14.00–14.15.

  3. Massicotte L, Lenis S, Thibault L, Sessine M, Seel R, Roy A. Effect of low central venous pressure on blood product transfusion requirements during liver transplantation. Liver Transplant. 2006;12:117–23.

    Article  Google Scholar 

  4. Roberts MS, Angus DC, Bryce CL, Valenta Z, Weissfeld L. Survival after liver transplantation in United States; a disease specific analysis of the UNOS database. Liver Transplant. 2004;10:886–97.

    Article  Google Scholar 

  5. National Institutes of health consensus development conference statement; Liver Transplantation. 1983. Hepatology. 1984;4:107S–10S.

    Article  Google Scholar 

  6. Seaberg EC, Belle SH, Beringer KC, Schivins JL, Detre KM. Liver transplantation in the United States from 1987-1998 updated results from Pitt-UNOS liver transplant registry. In: Cecka JM, Terasaki PI, editors. Clinical transplants 1998. vol 14. Los Angeles: UCLA Tissue Typing Laboratory; 1999. p 17–37.

  7. Munoz SJ, Rothstein KD, Reich D, Manzarbeitia C. Long term care of liver transplant recipient. Clin Liver Dis. 2000;4:691–710.

    Article  PubMed  CAS  Google Scholar 

  8. Peter E, Potter JM, Pesce AJ. Clinical chemistry and post liver transplant monitoring. Clin Chem. 1997;43:1546–54.

    Google Scholar 

  9. Tram T, FredPoordad F, Martin P. Advances in liver transplantation. Postgrad Med. 2004;115:73–85.

    Google Scholar 

  10. Berg Meyer HU, Horder M, Rej R, International Federation of Clinical Chemistry (IFCC). Scientific committee, analytical section, approved recommendation on IFCC methods for the measurement of catalytic concentration of enzymes part-2 IFCC method for aspartate aminotransferase. J Clin Chem Clin Biochem. 1985;1986(24):497–510.

    Google Scholar 

  11. Berg Meyer HU, Horder M, Rej R, International federation of clinical chemistry (IFCC). Scientific committee, analytical section, approved recommendation on IFCC methods for the measurement of catalytic concentration of enzymes part-3 IFCC method for alanine aminotransferase. J Clin Chem Clin Biochem. 1985;1986(24):481–95.

    Google Scholar 

  12. Tietz NW, Rinker D. Shaw LM IFCC methods for the measurement of catalytic concentration of enzymes part-5 IFCC method for alkaline phosphatase. J Clin Chem Clin Biochem. 1983;21:731–48.

    PubMed  CAS  Google Scholar 

  13. Shaw M, Stromme H, London L, Theodorsen L. Part-4 IFCC method for gamma glutamyltransferase. Clin Chem Clin Biochem. 1983;21:633–46.

    CAS  Google Scholar 

  14. Tolman KG, Rej R. Liver function. In: Burtis CA, Ashwood ER, editors. Tietz textbook of clinical chemistry Philadephia: WB Saunders Company; 1999. p 1136–37.

  15. van den Hymans Bergh AA, Mueller P. Ueber eine direkte and indirekte diazoreaktion auf bilirubin. Biochem Z. 1916;77(77):90–103.

    Google Scholar 

  16. Weichsel Baum TC. An accurate and rapid method for the determination of proteins in small amounts of blood serum and plasma. Am J Clin Pathol. 1946;16:40–8.

    Google Scholar 

  17. Dourmas BT, Watson WA, Biggs HG. Albumin standards and the measurement of serum albumin with bromocresol green. Clin Chim Acta. 1971;31:87–96.

    Article  Google Scholar 

  18. Wiesner RH, Ludwig J, van Hoek B, Krom RA. Current concepts in cell-mediated hepatic allograft rejection leading to ductopenia and liver failure. Hepatology. 1991;14:721–9.

    Article  PubMed  CAS  Google Scholar 

  19. Klintmalm GB, Nery JR, Husberg BS, Gonwa TA, Tillery GW. Rejection in liver transplantation. Hepatology. 1989;10:978–85.

    Article  PubMed  CAS  Google Scholar 

  20. Emond JC, Thistlethwaite JR, Baker AL. Rejection in liver allograft recipients: clinical characterization and management. Clin Transplant. 1987;1:143–50.

    Google Scholar 

  21. Ascher NL, Stock PG, Bumgardner GL, Payne WD, Najarian JS. Infection and rejection of primary hepatic transplant in 93 consecutive patients treated with triple immunosuppressive therapy. Surg Gynecol Obstet. 1988;167:474–84.

    PubMed  CAS  Google Scholar 

  22. Oguma S, Belle S, Starzl TE, Demetris AJ. A histometric analysis of chronically rejected human liver allografts: insights into the mechanisms of bile duct loss: direct immunologic and ischemic factors. Hepatology. 1989;9:204–9.

    Article  PubMed  CAS  Google Scholar 

  23. Krom RA, Wiesner RH, Rettke SR, Ludwig J, Southorn PA, Hermans PE, Taswell HF. The first 100 liver transplantations at the Mayo Clinic. Mayo Clin Proc. 1989;64:84–94.

    Article  PubMed  CAS  Google Scholar 

  24. Goldberg DM. Diagnostic enzymology. In: AG Gornall, editor. Applied biochemistry of clinical disorders. Hagerstown: Harper & Row; 1972. p 122–23.

  25. Liu F, Li Y, Lan X, Wei Y-G, Li B, Yan L-N, Wen T-F, Zhao J-C, Xu M-Q, Wang W-T, Yang J-Y. Tacrolimus dosage requirements in living donor liver transplant recipients with small- for-size grafts. World J Gastroenterol. 2009; 15:3931–6.

    Google Scholar 

  26. Kryszewski AJ, Neale G, Whieield JB, Moss DW. Enzyme changes in experimental biliary obstruction. Clin Chim Acta. 1973;47:175–82.

    Article  PubMed  CAS  Google Scholar 

  27. Knight JA, Haymond RE. Gamma-glutamyltransferase and alkaline phosphatase activities compared in serum of normal children and children with liver disease. Clin Chem. 1981;27:48–51.

    PubMed  CAS  Google Scholar 

  28. Lombardi B. On the nature, properties and significance of oval cells. In: Pani P, Feo F, Columbano A, editors. Recent trends in chemical carcinogenesis. vol 1. Cagliari, Italy: ESA; 1982. p. 37–56.

  29. Tanaka M. A histochemical study on the activity of y-glutamyl- transpeptidase in liver disease. Acta Pathol Jpn. 1974;24:651–5.

    PubMed  CAS  Google Scholar 

  30. Hickman PE, Lynch SV, Potter JM, Walker NI, Strong RW, Clouston AD. Gamma glutamyl transferase as a marker of liver transplant rejection. Transplantation. 1994;57:1278–80.

    Article  PubMed  CAS  Google Scholar 

  31. Mahajani RV, Cotler SJ, Uzer MF. Efficacy of endoscopic management of anastomotic biliary strictures after hepatic transplantation. Endoscopy. 2000;32:943–9.

    Article  PubMed  CAS  Google Scholar 

  32. Yi M, Wang G-D, He X-S, Li J-L, Zhu X-F, Hu R-D. Clinical and pathological analysis of acute rejection following orthotopic. Liver Transplant. 2009;122:1400–3.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Pradeep Naik.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Naik, P., Sritharan, V., Bandi, P. et al. A Single Centre Prospective Study of Liver Function Tests in Post Liver Transplant Patients. Ind J Clin Biochem 28, 38–45 (2013). https://doi.org/10.1007/s12291-012-0245-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12291-012-0245-4

Keywords

Navigation