Changes in liver enzymes after clinical islet transplantation.
BACKGROUND
Clinical islet transplantation (ITx) shows insulin independence with adequate metabolic control in patients with type 1 diabetes. The aim of this study was to characterize the pattern of elevation in liver enzymes observed after ITx and to investigate any correlation between these elevations and graft characteristics or graft functional outcome.


METHODS
Eighty-four consecutive ITx procedures were performed in 42 recipients. Liver function tests (LFT) were assessed during the first 40 days posttransplant. LFT elevated greater than or equal to 2.5 times above the upper limit of normal (ULN) were considered relevant.


RESULTS
In 54% of the transplants, the aspartate aminotransferase (AST) increased by more than 2.5 times above ULN. A 5-fold increase in AST was observed in 27% of the procedures. The highest AST levels were observed after the first ITx. AST for all transplants peaked at 7+/-0.5 days at a value of 162+/-23 U/L (P<0.001, compared with the pretransplant values). Changes in alanine aminotransferase were similar to AST. Alkaline phosphatase increased more than 2-fold above ULN in 12% of the procedures. LFT normalized in 90% of the recipients within 4 weeks posttransplant. The remaining 10% normalized within 2 months after ITx. Graft characteristics and graft function were not significantly different when comparing LFT with greater than 5-fold versus less than 2.5-fold increase above ULN. The mean bilirubin remained within the normal range.


CONCLUSIONS
After intraportal ITx, a significant increase in LFT levels was noticed in more than 50% of the procedures. These levels normalized spontaneously in 90% of the recipients within 4 weeks. No correlation between the increase in LFT and graft characteristics or graft function was found.
Rafael
Ehab
E
Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
Ryan
Edmond A
EA
Paty
Breay W
BW
Oberholzer
Jose
J
Imes
Sharleen
S
Senior
Peter
P
McDonald
Charlotte
C
Lakey
Jonathan R T
JR
Shapiro
A M James
AM
D000410:Alanine Transaminase / Q000097:blood*; D000469:Alkaline Phosphatase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D001663:Bilirubin / Q000097:blood*; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D016381:Islets of Langerhans Transplantation / Q000502:physiology*; D008111:Liver Function Tests; D018579:Patient Selection; D011184:Postoperative Period; D012016:Reference Values; D012044:Regression Analysis; D012086:Reoperation; D013997:Time Factors
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase; D001663:Bilirubin