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Transient hyperphosphatasemia following pediatric liver transplantation in a patient with hepatic and skeletal

Vishakantha Murthy1, Ghaith Altawallbeh1, Catherine Larson-Nath2

  • 1Department of Laboratory Medicine and Pathology, School of Medicine, University of Minnesota, Minneapolis, MN, USA.

Clinica Chimica Acta; International Journal of Clinical Chemistry
|April 7, 2021
PubMed

Insights

Transient hyperphosphatasemia (TH) was identified in a pediatric liver transplant patient with hepatic and skeletal issues. This finding suggests TH may be more common in this specific patient group than previously thought.

Area of Science:

  • Pediatric Gastroenterology
  • Hepatology
  • Transplantation Immunology

Background:

  • A pediatric patient with progressive familial intrahepatic cholestasis type-2 and osteoporosis experienced elevated liver function tests.
  • The patient underwent a second liver transplantation at one year of age, with initial improvement in liver function tests.

Observation:

  • Four months post-transplantation, unexplained elevations in alkaline phosphatase (ALP) persisted for nine months.
  • Differential diagnoses considered included viral infections and macro-ALP.

Findings:

  • A persistent trend of elevated ALP led to the diagnosis of transient hyperphosphatasemia (TH).
  • This case represents a previously undescribed population of TH patients: pediatric liver transplant recipients with hepatic and skeletal abnormalities.

Implications:

  • The observed prevalence of TH (4.3%) in pediatric liver transplant recipients within this healthcare system is notably higher than previously reported US prevalence (2.1%).
  • This highlights the need to consider TH in pediatric liver transplant patients presenting with isolated elevated ALP and skeletal/hepatic abnormalities.
Abstract

Keywords:
Alkaline phosphataseAlkaline phosphatase isoenzymePediatric liver transplantTransient hyperphosphatasemia

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