Liver Function, Abnormal

Acceptability at Recruitment

QUALIFIED

Acceptability at CT / Work-Up

QUALIFIED

Individual at Risk

Donor, Recipient

Explanation of Condition

Abnormality of one or more of the standard enzyme tests used to assess liver function. These include:

ALT (Alanine transaminase)

AST (Aspartate transaminase)

ALP (Alkaline phosphatase)

GGT (Gamma-glutamyl transpeptidase)

Acceptability for donation depends on the degree of elevation of LFTs. There are many causes for elevated LFTs, but in the UK the most common cause is non-alcoholic fatty liver disease (NAFLD).

For elevated bilirubin, please see High bilirubin

Guidance

If LFTs are less than twice the upper limit of normal:

The donor can be cleared. For donor health, a repeat value should be checked. This can be done by either checking LFTs on day of donation (DOD), or by asking the donor's GP to re-check their LFTs once the donation is complete. If LFTs are checked on DOD and remain abnormal, GP follow-up should be arranged.

If LFTs are greater than twice the upper limit of normal but less than thrice upper limit of normal:

Review the following tests from the medical assessment:

• Infectious disease marker results (HIV, Hepatitis, EBV, CMV etc). Abnormal virology results should be followed up as appropriate (see the relevant pages).
• Ferritin.
• Markers of hepatic synthetic function (albumin, coagulation screen, platelets, bilirubin). If blood tests suggest hepatic dysfunction, discuss this with an SMO/donor consultant.

Arrange the following tests:

• Liver USS.
• A standard liver profile: AST, ALP, GGT.
• Autoantibodies (anti-mitochondrial Abs, anti-smooth muscle Abs and ANAs).
• Immunoglobulins.
• HbA1c.
• Transferrin saturation (if abnormal ferritin).

If fatty liver is identified on ultrasound and all other tests are normal, the donor can be cleared. A letter should be written to their GP to repeat liver enzymes in 3 months’ time and continue follow up.

If any other abnormalities suggestive of more advanced NAFLD such as steatosis are identified on ultrasound, a fibroscan should be arranged.

If a fibroscan demonstrates NASH or cirrhosis, the donor cannot be cleared.

If liver function tests are greater than thrice the upper limit of normal:

Arrange repeat LFTs. If the repeat result is the same, the donor cannot be cleared.

Pseudonyms or Related Conditions

LFT

LFTs

Version

Version 1, Edition 1

Date of Last Update

16th October 2012