DDSEP® 8 Quick Quiz

June 2018 Question 1

Publish date: May 29, 2018

A 62-year-old man underwent deceased-donor liver transplant 36 hours ago for decompensated chronic hepatitis C cirrhosis. He did well initially posttransplant with a steady decline in his transaminases and improvement in hepatic synthetic function. But he has had a rapidly progressive decline in his clinical status over the past 12 hours. On physical exam, his mental status is notable for new confusion. His temperature is 38.9 ºC. Laboratory data reveal the following:
AST 10,300 U/L
ALT 14,550 U/L
total bilirubin 9.6 mg/dL
alkaline phosphatase 693 IU/L
INR 3.6
creatinine 4.6 mg/dL with oliguria.

What is the next most important diagnostic test for this patient?

CMV PCR

Liver biopsy

Hepatic ultrasound with Dopplers

ERCP

MRCP

Correct answer: C

Rationale

This patient is presenting early post-liver transplant with severe hepatic dysfunction. This severity of enzyme elevation is concerning for an underlying hepatic artery thrombosis. The next appropriate diagnostic test for this patient is a hepatic ultrasound with Dopplers to assess hepatic artery patency. CMV infection does not typically occur within the first month post-liver transplant and would not be expected to cause this degree of elevation in the liver enzymes. Performance of liver biopsy, MRCP, or ERCP would not reveal the underlying etiology and may result in delay in diagnosis.

Reference

1. Stange BJ, Glanemann M, Nuessler NC, et al. Hepatic artery thrombosis after adult liver transplantation. Liver Transplantation 2003;9:612-20.

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