CLINICAL-CHEMISTRY AND POST-LIVER-TRANSPLANT MONITORING

Liver transplantation is an accepted therapy for endstage liver diseas e. After allografting, a variety of clinical problems may require labo ratory involvement for accurate and timely diagnosis and intervention. Critical factors in the choice of a laboratory test menu to support a transplant program include turnaround times that support clinical dec isionmaking, real diagnostic value, and real value for money. Particul ar clinical problems, whose early presentation must be anticipated, in clude graft ischemia, primary nonfunction, and hepatic artery thrombos is. Acute rejection is common at 5-10 days posttransplantation, the pr incipal target being the biliary tree. Longer-term problems are associ ated with the therapeutic drug measurement of cyclosporin A and, incre asingly, tacrolimus (FK506); the side effects of immunosuppressant the rapy also require monitoring. A successful liver transplant program ca n be adequately supported with a simple battery of automated tests tha t ape cheap, fast, and available at all times.