Transient hyperphosphatasemia following pediatric liver transplantation in a patient with hepatic and skeletal abnormalities

Vishakantha Murthy, Ghaith Altawallbeh, Catherine Larson-Nath, Amy B. Karger, Stefani N. Thomas

Research output: Contribution to journalArticlepeer-review


Background: We report a unique case of transient hyperphosphatasemia in a pediatric patient with a history of hepatic and skeletal abnormalities. Patient and Methods: A 2-month old male was diagnosed with progressive familial intrahepatic cholestasis type-2 and osteoporosis after marked increases in liver function tests were noted at 1 month of age. He underwent a second liver transplantation at 1 y. The increased liver function test trend resolved a few weeks post-transplantation. Four months after successful liver transplantation, unexplained significant increases in alkaline phosphatase (ALP) were observed, and they persisted for almost 9 months. Among the etiologies under consideration for the isolated increased ALP activity were viral infections and macro-ALP. Results: A persistent trend in abnormally increased ALP for 9 months was investigated leading to a confirmed diagnosis of transient hyperphosphatasemia (TH). Conclusion: Pediatric post-liver transplant patients with skeletal and hepatic abnormalities including isolated markedly increased ALP activities represent a previously undescribed TH patient population. The 4.3% prevalence of TH in pediatric liver transplant recipients within our healthcare system is considerably higher than the previously reported prevalence of 2.1% for patients within the United States.

Original languageEnglish (US)
Pages (from-to)48-50
Number of pages3
JournalClinica Chimica Acta
StatePublished - Aug 2021

Bibliographical note

Publisher Copyright:
© 2021 The Author(s)


  • Alkaline phosphatase
  • Alkaline phosphatase isoenzyme
  • Pediatric liver transplant
  • Transient hyperphosphatasemia


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