title: Characterization of liver enzymes on living related liver transplantation patients with acute rejection.
abstract: 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.
authors.affiliation: Liver Transplant Program, Division of Hepato-Gastroenterology, Chang Gung University, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Taiwan.
authors.forename: King-Wah
authors.initials: KW
authors.lastname: Chiu
authors.forename: Yaw-Sen
authors.initials: YS
authors.lastname: Chen
authors.forename: Vanessa H
authors.initials: VH
authors.lastname: de Villa
authors.forename: Chih-Chi
authors.initials: CC
authors.lastname: Wang
authors.forename: Hock-Liew
authors.initials: HL
authors.lastname: Eng
authors.forename: Shih-Hor
authors.initials: SH
authors.lastname: Wang
authors.forename: Por-Ping
authors.initials: PP
authors.lastname: Liu
authors.forename: Bruno
authors.initials: B
authors.lastname: Jawan
authors.forename: Tung-Liang
authors.initials: TL
authors.lastname: Huang
authors.forename: Yu-Fan
authors.initials: YF
authors.lastname: Cheng
authors.forename: Chao-Long
authors.initials: CL
authors.lastname: Chen
mesh_terms: 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
chemical_list: D015415:Biomarkers; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase