title: Late liver function test abnormalities post-adult liver transplantation: a review of the etiology, investigation, and management.
abstract: Approximately 24,000 liver transplants are performed annually worldwide, almost 7000 of which are performed in the USA. Survival is excellent and continues to improve, with 1-year survival currently exceeding 85 %, but effective management of patients after liver transplantation is critical to achieve optimal results. A plethora of diseases can affect the transplanted allograft, ranging from recurrence of the original disease to de novo liver pathology, and diagnosis can be complicated by nonclassical presentation, de novo disease, or inconclusive histology. Patients can remain asymptomatic despite significant damage to the transplanted liver, so prompt identification and treatment of liver disease after transplantation is crucial to preserve allograft function. Liver function tests are routinely taken throughout the postoperative period to monitor the graft. Although nonspecific, they are inexpensive, noninvasive, and sensitive for allograft disease and can quickly alert physicians to the presence of asymptomatic pathology. This review will outline possible causes of liver function test abnormalities in the late posttransplant period and provide guidance for investigation, diagnosis, and management.
authors.affiliation: Transplant Hepatology, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross Research Building, 918, Baltimore, MD, USA.
authors.forename: Oscar
authors.initials: O
authors.lastname: Mitchell
authors.affiliation: Transplant Hepatology, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross Research Building, 918, Baltimore, MD, USA.
authors.forename: Arif M
authors.initials: AM
authors.lastname: Cosar
authors.affiliation: Department of Internal Medicine, Conemaugh Memorial Hospital, Johnstown, PA, USA.
authors.forename: Mohammad U
authors.initials: MU
authors.lastname: Malik
authors.affiliation: Transplant Hepatology, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross Research Building, 918, Baltimore, MD, USA. aguraka1@jhmi.edu.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Gurakar
mesh_terms: D006084:Graft Rejection / Q000209:etiology*; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D008111:Liver Function Tests / Q000706:statistics & numerical data*; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D011182:Postoperative Care / Q000379:methods; D012008:Recurrence
keywords: Etiology of abnormal liver function tests; Liver function tests; Liver transplant