What condition is indicated by elevated alkaline phosphatase and GGT post liver transplant with normal bilirubin and aminotransferases?

The scenario of elevated alkaline phosphatase and GGT following a liver transplant, combined with normal bilirubin and aminotransferases, is indicative of an issue related to bile flow rather than liver parenchymal damage or acute cellular injury.

In this case, elevated alkaline phosphatase and GGT suggest a cholestatic pattern, which points towards a disruption in bile flow. Bile duct obstruction is often characterized by elevated alkaline phosphatase but typically also presents with increased bilirubin levels due to accumulation of bile acids backing up into the liver and bloodstream. Normal bilirubin levels in this scenario suggest that while there may be cholestasis, it is not due to obstruction of the bile duct but rather a condition that is affecting the bile flow.

Cholestasis can occur post-liver transplant as a result of preservation injury, particularly if there was an ischemic or a perfusion problem with the transplanted liver. Preservation injury occurs when there is damage due to factors surrounding the procurement and storage of the liver organ before transplantation, affecting the function of bile ducts and bile production.

This context helps to clarify that while bile duct obstruction manifests similarly with elevated alkaline phosphatase, the presence of normal bilirubin combined with the other findings suggests that