A patient 2 weeks post LDLT for HBV induced ESLD, developed raised transaminases with ALT max 700 and raised GGT, ALP, >1000, normal T. Bilirubin, normal CRP,normal WBCs...his biopsy was negative for rejection or viral reactivation twice, his HBc Ab IgM was negative, his CMV level was not detected, no biliary dilatation in US, he had collection in US and was drained US guided.
He is on FK since post op. and his trough level always bellow 15 ng, enzymes decrease spontaneously and re rised again.
What about FK hepatotoxicity and should we shift him to Cyclosporin?
Not quite experienced on TAC toxicity, which by the way would be hard to prove. My advice would be angio-CT if not previously performed to rule out vascular issues. Were there any other histological findings in the liver biopsy? A face to face interview with the pathologist use to shed some light on these difficult-to-manage patients.
If there is no abnormality on imaging and you are still having problems with the LFt's then you may need to look into Ab mediated rejection as a possible cause.
US doppler already done , and showed patent vessels , MRCP also done abd showed no abnormalties except small hematoma on cut surface with non dilated biliary channels....We already had interview with the pathologist and reviewed the slides together without any evident of rejection or viral reactivation
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