false hope

[worriedtransplantmum]

My daughter is 2 yrs post transplant and in rejection for 3 months and has been unresponsive to medication. This week her bloods showed a very slight improvement in her lfts but now her billirubin is rising, which has been normal for 2 months. Does this mean the decrease in her lfts is not worth getting excited about? can they vary day to day? or could it just be the increased immune suppression masking the results?

[Thomas D Schiano, MD]

i think that she needs a liver biopsy.  patients suffering from acute liver failure may develop a plasma cell hepatitis like autoimmune hepatitis.  This is not true rejection but might require increased immunosuppression.  i presume that imaging studies have not revealed a stricture.

[worriedtransplantmum]

I would like your opinion on what is happening now. My daughters lfts have continued to rise todays results are alp 439 (a slight decrease) alt 470, ast 339 and ggt 793. tests on her immune system show she is really supressed the c25 marler was 0 so they said she cant be in rejection anymore but i dont understand why her lfts keep rising! Her liver function is stable with her billi albumin and clotting all normal. this is going on for so long and i feel like im just waiting for her to get ill again. Her transplant was due to Acite liver failure of unknown etiology. Do you think her liver could just be failing again?

[Thomas D Schiano, MD]

there can be transient improvements in the liver tests but as it takes a long time to heal chronic rejection (presumably that's what she has, stemming from acute rejection) its important to follow trends over time.  Increases and decreases such as this are commonplace