Characterization of liver enzymes on living related liver transplantation patients with acute rejection.
OBJECTIVE
To determine the biochemical data that reliably predict allograft injury from acute rejection (AR) in patients with living related liver transplantation (LRLT), liver function test and histopathological characteristics of AR were compared and analyzed retrospectively.


METHODS
From Aug. 1994 to Nov. 2000, 101 cases received orthotopic liver transplantation (OLT), which included 53 patients with LRLT in our series. Completed liver functions including aspartate transferase (AST), alanine transferase (ALT), bilirubin total/direct (Bil.T/D), alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (GGT) were collected with peak level when AR was diagnosed by liver biopsy. The best data of the same patients when disease free, were compared and analyzed with non-parametric Wilcoxon signed ranks test and Mann-Whitney test. All of the ARs were reversed with steroid pulse therapy, and two cases converted to FK506. No steroid-resistant rejection or chronic rejection was found in our series.


RESULTS
In the patients with LRLT, 17 episodes in 13 patients with AR were found. The incidence of histological analysis proved AR was 12.9% (13/101) in OLT and 24.5% (13/53) in LRLT respectively. Among the liver function tests, AST (p<0.0001), ALT (p<0.0001), Bil.T (p=0.001), Bil.D (p=0.001), GGT (p<0.0001), and INR (p=0.034) were the significant predictors respectively in the patients with AR episode. Once liver enzymes had elevated, the AST/ALT ratio <1.0 showed a more significant difference in AR than in those of the no rejection group (p<0.0001). ALP showed significant difference in our series. The severity of histological change was not correlated to the degree of liver enzymes elevation.


CONCLUSIONS
Complete liver function tests especially AST, ALT, Bil.T/D, GGT and the ratio of AST/ALT are very sensitive tests in a group of patients receiving LRLT with AR. The severity of AR is based on the histopathologic change but is not related to the degree of liver enzymes elevation itself. Meanwhile, the outcome of acute rejection in living related liver transplantation is quite good.
Chiu
King-Wah
KW
Liver Transplant Program, Division of Hepato-Gastroenterology, Chang Gung University, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Taiwan.
Chen
Yaw-Sen
YS
de Villa
Vanessa H
VH
Wang
Chih-Chi
CC
Eng
Hock-Liew
HL
Wang
Shih-Hor
SH
Liu
Por-Ping
PP
Jawan
Bruno
B
Huang
Tung-Liang
TL
Cheng
Yu-Fan
YF
Chen
Chao-Long
CL
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000410:Alanine Transaminase / Q000032:analysis*; D000469:Alkaline Phosphatase / Q000032:analysis*; D015415:Biomarkers / Q000032:analysis; D001707:Biopsy, Needle; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis / Q000453:epidemiology*; D006085:Graft Survival; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D007223:Infant; D017093:Liver Failure / Q000175:diagnosis / Q000601:surgery; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D014184:Transplantation, Homologous / Q000009:adverse effects
D015415:Biomarkers; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase