Marked transient alkaline phosphatemia following pediatric liver transplantation
B. Koneru, E. Carone, J. J. Malatack, C. O. Esquivel and T. E. Starzl
Department of Surgery, University of Pittsburgh, Pa.
An isolated marked transient rise in serum alkaline phosphatase levels in
otherwise healthy children is a well-documented occurrence. However, in
children undergoing liver transplantation, elevated alkaline phosphatase
values raise the possibility of biliary obstruction, rejection, or both.
During a 6-year period, 6 of 278 children undergoing liver transplantation
exhibited a similar phenomenon as an isolated abnormality. None had
rejection, biliary obstruction, or other allograft dysfunction during a
long follow-up. Eventually and without intervention, the alkaline
phosphatase levels returned to normal. These instructive cases suggest that
caution be used in advocating invasive procedures if elevated alkaline
phosphatase levels are an isolated abnormality, and close observation with
noninvasive testing is recommended.