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June 1989

Marked Transient Alkaline Phosphatemia Following Pediatric Liver Transplantation

Author Affiliations

From the Departments of Surgery (Drs Koneru and Starzl) and Pediatrics (Dr Malatack), University of Pittsburgh, Pa; the Department of Surgery, University of São Pãulo, Brazil (Dr Carone); and the Division of Transplantation, Pacific Presbyterian Medical Center, San Francisco, Calif (Dr Esquivel). Dr Koneru is now with the Liver Transplant Division, Univesity Hospital, Univeristy of Medicine & Dentistry of New Jersey, Newark.

Am J Dis Child. 1989;143(6):669-670. doi:10.1001/archpedi.1989.02150180047018

• 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.

(AJDC. 1989;143:669-670)

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