elevated AST/ALT/GGT post renal transplant

I am 21 mos out of a renal transplant.      Recently I have lab results with increasing liver enyzmes.    ALT=265, AST = 131, GGT=220.   Neg for hep b/c.    I haven't had any new medications since transplant with the following exceptions, all of which were discontinued 3 weeks prior to the first lab indicating elevated enzymes:   one week penicillin concurrent with one week acyclovir, one week mouthwash (swallow) with hydrocortisone powder, nystatin, tetracycline, and diphenhydramine.    two weeks tylenol, sporadically, never more than 3 g in one day.

At the time of the test, I was still taking viscous lidocaine for throat ulcers.   Used two 100 ml bottles in four weeks, just started third bottle.

I seem to either be having a gastroparesis flare or something else.    Nausea until I eat in the morning, abdominal pain after eating, gurgling, weight loss, no appetite, difficulty in staying even hydrated.   I supplement with ensure.

Throat ulcers are two:   larger than a quarter, one on each side of the uvula.     Finally 99% healed, no new ulcers in the last four weeks.

Is this just a watch and wait situation?   What else should I be tested for?

The next set of labs is for a hepatic panel, g6pd, and a repeat cmv (one previous test was negative).    Throat was negative for herpes.   Cultures for ebv and coxsackin on the throat never came back.

[Thomas D Schiano, MD]

i would check HCV and HBV PCR as well as EBV PCR.  Also, I would check a CT scan or U/S of the liver.  what are the alkaline phosphatase and bilirubin levels?  These are not dangerously elevated so watchful waiting is reasonable.

[gt1111]

HCV Ab w/Rlfx to RIBA was negative (0.2), Hep B surface Ab 0.14, HBsAg negative, Hep B Core Ab, Tot negative so I am fairly confident it is not HCV or HBV.    I was also thinking of adding an EBV.     Alkaline Phosphatase is normal at 120, Bilirubin (total) normal at 0.5, Bilirubin (direct) normal at 0.26.   Thank you for your input!    I am sure my docs will press forward with CT or U/S if the levels remain elevated.   I'll let you know what I find out since I seem to be an odd and interesting case ;)

[Thomas D Schiano, MD]

sure.  keep me in the loop.