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

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.

The long-term outcomes of deceased-donor liver transplantation for primary biliary cirrhosis: a two-center study in China

“…In a retrospective study of 75 liver transplant patients, transaminase activities reached 10-12 times above the upper limits of normal on the first day after surgery and reached a normal range by the ninth day, similar to our results. These findings suggest that the early peaks of transaminase activity represent preservative damage during liver removal from the donor and subsequent ischemia-reperfusion injury during transplantation (Naik et al, 2013). In our study, the frequency of IGPF was 21.7%, which was lower than that in other studies (29.5%) (Chui et al, 2000).…”

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“…However, we believe this is likely an underestimate, with a large proportion of the GGT events not yet diagnosed representing preservation-reperfusion injury during this period, with misclassification secondary to a lack of confirmatory liver biopsy as it is not a structured component of care at our center. This is supported by Naik and associates, 6 who showed elevations in GGT among liver transplant recipients who did not have acute rejection during the immediate period after transplant. Of note, there was a significant discrepancy in GGT trends between liver transplant recipients with HCV versus those without HCV.…”

“…6 We found that GGT values commonly peak within the first month after liver transplant and subsequently return to within normal parameters by 1 year. The peak in GGT within the first month is likely secondary to preservation-reperfusion injury.…”

“…However, there is currently no standardized approach among transplant centers regarding which liver biochemical tests should be used and the frequency at which they should be performed, most notably regarding gamma-glutamyl transpeptidase (GGT). Interestingly, GGT has recently begun to garner increased attention as a potentially useful diagnostic tool for complications after liver transplant such as acute rejection, 5,6 biliary complications, 7 and primary liver disease recurrence. 8 However, the temporal trends in GGT after transplant and the disease processes commonly leading to abnormal GGT values remain undefined, thus limiting its use at this time.…”

Validez de la fórmula del volumen de un elipsoide para establecer el volumen de la cavidad abdominal en un modelo experimental en ratas

“…Es esperado que su ejecución en sujetos con insuficiencia hepática e incremento en el INR se asocie a una mayor probabilidad de morbilidad posoperatoria e incluso mortalidad si se lleva a cabo en el contexto de una cirugía urgente. El escenario presente cuando los pacientes con insuficiencia hepática e INR prolongado se someten a trasplante hepático es distinto, ya que las variables afectadas por la insuficiencia hepática tienden a mejorar progresivamente en el transcurso de las siguientes dos semanas después del trasplante (18,19).…”