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Review
. 2023 Feb;27(1):103-115.
doi: 10.1016/j.cld.2022.08.006. Epub 2022 Oct 18.

Evaluation of an Abnormal Liver Panel After Liver Transplantation

Jacqueline B Henson  1 , Andrew J Muir  2
Affiliations
Review

Evaluation of an Abnormal Liver Panel After Liver Transplantation

Jacqueline B Henson et al. Clin Liver Dis. 2023 Feb.

Abstract

Abnormal liver tests are common after liver transplantation. The differential diagnosis depends on the clinical context, particularly the time course, pattern and degree of elevation, and donor and recipient factors. The perioperative period has distinct causes compared with months and years after transplant, including ischemia-reperfusion injury, vascular thrombosis, and primary graft nonfunction. Etiologies seen beyond the perioperative period include biliary complications, rejection, infection, recurrent disease, and non-transplant-specific causes. The evaluation begins with a liver ultrasound with Doppler as well as appropriate laboratory testing and culminates in a liver biopsy if the imaging and laboratory testing is unrevealing.

Keywords: Biliary complications; Hepatic artery thrombosis; Liver tests; Liver transplantation; Primary nonfunction; Recurrent disease.

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Conflict of interest statement

Disclosure JBH is supported by NIH grant 2T32DK007568-31A1.

Figures

Figure 1.
Figure 1.
Etiologies of abnormal liver tests in a liver transplant recipient by pattern of elevation and time course. Abbreviations: AIH, autoimmune hepatitis; COVID-19, coronavirus-19; CMV, cytomegalovirus; EBV, Epstein-Barr virus; HAT, hepatic artery thrombosis; PBC, primary biliary cholangitis; PSC, primary sclerosing cholangitis; PVT, portal vein thrombosis.
Figure 2.
Figure 2.
Differential diagnosis and diagnostic evaluation of abnormal liver tests in a hepatocellular pattern in liver transplant recipients by time period. Abbreviations: AIH, autoimmune hepatitis; COVID-19, coronavirus-19; CMV, cytomegalovirus; EBV, Epstein-Barr virus; HAT, hepatic artery thrombosis; PNF, primary nonfunction; PVT, portal vein thrombosis; U/S, ultrasound.
Figure 3.
Figure 3.
Differential diagnosis and diagnostic evaluation of abnormal liver tests in a cholestatic pattern in liver transplant recipients by time period. Abbreviations: HAT, hepatic artery thrombosis; PBC, primary biliary cholangitis; PSC, primary sclerosing cholangitis; U/S, ultrasound.
See this image and copyright information in PMC

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