Elevated ALP - post splenectomy

[ncinr]

My husband had a splenectomy almost 3 months ago.  He went in for a liver transplant (MELD was 18) and they discovered that his liver was fine and they aborted the liver transplant.  He also has a portal vein clot which was there before the splenectomy and has now extended down to his superior mesenteric vein.  His spleen was 5.35 lbs. They also removed his gallbladder which was fine and his bile ducts were fine.  Since the splenectomy his ALP has been elevated and has not returned to normal.  It is currently 453 and his AST is 67.  What would cause his ALP to be elevated since liver biopsies taken during the aborted liver transplant show no cirrhosis or fibrosis.

[Thomas D Schiano, MD]

bilirubin may not be elevated, maybe only alkaline phosphatase

[ncinr]

He's had a couple of CTs in the last month or so and they haven't mentioned problems with biliary ischemia or bile collection/leakage. If it was a bile problem, would his bilirubin be elevated?  His last bilirubin on 11/23 was normal at .9.  

[Thomas D Schiano, MD]

they must make sure that there is no biliary ischemia from the interrupted blood supply or a bile collection or leak from the gall bladder.  an MRCP or CT should be done, if not recently performed.