Investigation Of Liver Function Test Abnormalities

Liver function test abnormalities may consist of elevations in liver transaminases suggestive of hepatocellular necrosis or alkaline phosphatase and bilirubin suggestive of cholestasis. These two patterns of liver function abnormality are not mutually exclusive and can, therefore, occur simultaneously. However, the pattern of liver function abnormality may determine the most appropriate investigation algorithm by suggesting a cause for the laboratory abnormalities. In addition, the timing of the abnormalities may render some causes more suspect than others. The differential diagnosis of abnormal liver function tests include graft dysfunction, technical complications (vascular and biliary), immunological complications (rejection), infectious complications, and finally, recurrence of native disease (Table 9.17).

Graft dysfunction encompasses a wide spectrum ranging from mild to severe dysfunction. Mild dysfunction is manifested by a significant rise in transaminases postoperatively (above 2,500 IU) as a result of preservation injury. In addition, there may be a second peak in transaminases within 24 hours which is thought to be secondary to reperfusion injury. Regardless of the peak transaminase level, it is important that the trend in transaminase levels be downward. If transaminases

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