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 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