Difference between revisions of "Liver Function, Abnormal"
| (6 intermediate revisions by the same user not shown) | |||
| Line 19: | Line 19: | ||
GGT (Gamma-glutamyl transpeptidase) | 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). | + | Acceptability for donation depends on the degree of elevation of LFTs and the underlying cause. 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]] | For elevated bilirubin, please see [[High bilirubin]] | ||
| Line 40: | Line 40: | ||
* Markers of hepatic synthetic function (albumin, coagulation screen, platelets, bilirubin). If blood tests suggest hepatic dysfunction, discuss this with an SMO/donor consultant. | * 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 additional tests: | |
| − | Arrange the following tests: | ||
* Liver USS. | * Liver USS. | ||
| Line 50: | Line 49: | ||
* Transferrin saturation (if abnormal ferritin). | * Transferrin saturation (if abnormal ferritin). | ||
| − | + | If fatty liver is identified on ultrasound and all other tests are normal, the donor can be cleared. Lifestyle advice should be discussed, and a letter should be written to their GP to repeat liver enzymes in 3 months’ time. | |
| − | If fatty liver is identified on ultrasound and all other tests are normal, the donor can be cleared. | ||
If any other abnormalities suggestive of more advanced NAFLD such as steatosis are identified on ultrasound, a fibroscan should be arranged. | 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. The donor should be referred to Hepatology via their GP. | ||
| − | |||
| + | <b> If liver function tests are greater than thrice the upper limit of normal: </b> | ||
| + | |||
| + | Arrange repeat LFTs. If the repeat result is the same, the donor cannot be cleared. The donor should be referred to Hepatology via their GP. | ||
| − | |||
| − | + | For elevated bilirubin levels, please see [[High bilirubin]] | |
==Pseudonyms or Related Conditions== | ==Pseudonyms or Related Conditions== | ||
| Line 69: | Line 69: | ||
==Version== | ==Version== | ||
| − | Version 1, Edition | + | Version 1, Edition 2 |
====Date of Last Update==== | ====Date of Last Update==== | ||
| − | + | 4th June 2024 | |
Latest revision as of 13:38, 5 June 2024
Contents
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 and the underlying cause. 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 additional 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. Lifestyle advice should be discussed, and a letter should be written to their GP to repeat liver enzymes in 3 months’ time.
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. The donor should be referred to Hepatology via their GP.
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. The donor should be referred to Hepatology via their GP.
For elevated bilirubin levels, please see High bilirubin
Pseudonyms or Related Conditions
LFT
LFTs
Version
Version 1, Edition 2
Date of Last Update
4th June 2024
