Major Liver Injury Research Articles

Role of liver enzymes in patients with blunt trauma to liver on conservative management

Background: When blunt abdominal trauma occurs, the liver is the organ most often affected. The liver enzymes are often elevated in blunt trauma to the liver. However, the variation of liver enzymes among various grades of liver injury is not clear. The aim of our investigation is to determine the variation of liver enzymes across various grades of liver injury as well as whether it affects any change in management including surgical intervention. Methods: Our research was a prospective observational study. Patients of blunt abdominal trauma having a liver damage which was detected on a contrast CT scan and managed conservatively were included. They were categorized as per the AAST (American Association for the Surgery of Trauma) system. Various biochemical markers including liver enzymes were compared between the groups. Any change in management or need for intervention was found out. Results: A total of 35 patients has been included. Ages between 31 and 40 accounted for the majority of cases (34.3%). Our study showed male preponderance (85.7%). Most patients presented to the hospital within 24 hours of trauma (82.9%). Most of our patients had blood transfusions during their hospital stay (71.4%). AAST grade III injury was predominant (48.6%). Subgroup analysis between minor and major liver injury patients was done. No significant distinction was seen among the two groups concerning the assessed biochemical parameters. No significant variation was observed regarding the necessity for intervention. Conclusions: Liver enzymes can not be used to differentiate among various grades of liver injury. Patients who are managed conservatively can be managed so with close monitoring and supportive treatment without the need for any intervention. However, larger and randomized studies are needed to validate the results.

Initial Risk Stratification of Liver Injuries Based on Elevated Transaminases in a Medical Resource-Constrained Area

Liver injuries after blunt abdominal trauma vary from mild contusions to life-threatening damage, indicating that initial risk stratification of liver injuries is critical to improve clinical outcomes, especially in a medical resource-constrained area. This study analyzed 148 patients who underwent abdominal and chest computed tomography with elevated transaminases, with suspected liver injury after blunt abdominal trauma, between January 2008 and December 2017. The mean age was 49.6 (standard deviation 17.2) years; most patients were men (69.6%). The most common cause of trauma was motor vehicle accidents (55.4%), followed by falls (27.7%) and assault (11.5%). Patients with no liver injury (n = 63, 42.6%) and those with American Association for the Surgery of Trauma (AAST) grades I (n = 11, 7.4%) and II (n = 15, 10.1%) were treated with non-operative management. However, 2.8% of patients with AAST III (n = 36, 24.3%), 29.4% with AAST IV (n = 17, 11.5%), and 50.0% with AAST V (n = 6, 4.1%) required trans-arterial embolization, and patients with AAST IV and V had 11.8% and 33.3% mortality rates, respectively. Predictors for major liver injury (AAST IV and V) were aspartate aminotransferase ≥ 450 IU/L (p < 0.0005) and international normalized ratio ≥ 1.2 (p = 0.028). In conclusion, these laboratory values enable an initial risk stratification of liver injuries after blunt abdominal trauma that early appropriate treatment and, if not possible, a prompt transfer to a capable facility would be considered in patients who had the predictors of major liver injury.

Management modalities of isolated liver injury in blunt abdominal trauma

Background: The liver is one of the most commonly injured organ in blunt abdominal trauma. Management of liver injury due to blunt abdominal trauma has been dramatically evolved in recent years. Dramatic change from operative management to non-operative management has improved survival in these patients, becoming the standard of care for most liver injuries.Methods: A retrospective study of the patients admitted with the diagnosis of isolated liver injury due to blunt abdominal trauma between 2013-2018. Data collected of 30 patients of isolated liver injury who either treated conservative management of operative management. Variable analyzed included demographic data, mechanism of injury, associated injury, conservative treatment, operative treatment, morbidity, mortality, and hospital stay.Results: A total of 30 patients were analyzed of isolated liver injury due to blunt abdominal trauma, 27 patient sustained minor liver injury (grade I, II and III), whereas 3 patients had major liver injury (grade IV, V and VI). 25 cases due to road traffic accident and 5 cases were due to falls from a height. 27 patients with American Association for the surgery of trauma grade I, II, III and 2 patients with grade IV, V managed conservatively, surgical intervention required in 1 patient with grade V, mortality occurred in 1 patient out of 29 who were treated conservatively.Conclusions: Isolated liver injury is common in the blunt abdominal trauma patient. Most of the patients with the liver injury with hemodynamically stable treated conservatively. Only a few of them require surgical management if they are hemodynamically unstable.

2467 Recognizing Macrobid as a Potential Cause for Major Liver Injury

INTRODUCTION: Nitrofurantoin is one of the most commonly prescribed antibiotics for urinary tract infections. It is also one of the most common medications known to cause drug-induced liver injury (DILI). Nitrofurantoin can cause acute or chronic liver injury. Acute liver injury occurs within a few weeks of nitrofurantoin use and resolves quickly after discontinuation. Chronic liver injury typically presents months or years after use of nitrofurantoin and can also present as an autoimmune type reaction. This case demonstrates the need to have high suspicion for DILI when patients present with elevated liver enzymes with recent use of nitrofurantoin. CASE DESCRIPTION/METHODS: The patient is a 56 year old female with a past medical history of recurrent urinary tract infections including ESBL who presented with abdominal pain, diarrhea, and nausea for one month. Prior to symptoms onset, she had developed burning and odor in her urine and was treated with nitrofurantoin for 14 days. Urinary symptoms resolved after antibiotic completion. Two weeks later, the patient began to develop worsening abdominal pain that was accompanied by diarrhea and subjective fevers and chills. On presentation, the patient's vitals were found to be: 98.5F, HR 107, 156/74, and saturating well on room air. On labs, she was found to have elevated alkaline phosphatase of 200 U/L, ALT 1014 U/L, AST 2011 U/L, Total Bilirubin 1.0 mg/dL, Lipase 59 U/L, negative alcohol level, negative acetaminophen level, and negative viral hepatitis panel. CT Abdomen and Pelvis showed hepatic steatosis but no acute processes. Secondary workup for liver injury was largely negative except an ANA titer of 1:320. The patient was treated supportively and had a gradual decrease in her liver enzymes over the course of three days. DISCUSSION: DILI can be a difficult diagnosis to make because it is a diagnosis of exclusion. In our case, the patient experienced marked elevations in her liver enzymes that resolved with only supportive care. Her workup was negative and the only identifiable etiology of her acute liver injury was her nitrofurantoin use. Additionally, our patient was seen to have features of drug-induced autoimmune hepatitis with her ANA elevation suggesting a component of chronic liver injury. She had been treated with Nitrofurantoin in past infections as well. Since Nitrofurantoin can cause sometimes severe liver damage, the indication for its use should be evidence-based, and signs/symptoms of liver injury should lead to prompt cessation of therapy.

May liver transaminases substitute for computed tomography in evaluation of blunt liver injury? With special emphasis on serum cut-off levels

Background: Although computed tomography (CT) has become the standard diagnostic modality for patients with blunt liver trauma, it is costly and results in a marked increase in radiation exposure. Purpose of this study was to establish cut-off values for transaminases, and to interrogate the necessity of CT. Methods: Transaminase levels of all patients with blunt abdominal trauma admitted to our clinic from 2009 to 2014 were analysed, and compared to radiological findings and final outcome. Classification of injury was done according to the American Association for the Surgery of Trauma (AAST)'s hepatic injury scale. Chisquare and Mann–Whitney U tests were used for statistical analyses, and receiver operating characteristic (ROC) curve was performed to define the cut-off values for aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Results: Of the 285 patients with blunt abdominal trauma, 50 (17.5%) had radiological evidence of liver injury (Group 1). Remaining 235 (82.4%) had no liver injury (Group 2). Group 1 had significantly increased AST and ALT values compared to Group 2 (p=0,001). AST as well as ALT levels were significantly higher in patients with major liver injury. Optimal cut-off values for AST and ALT were 313 IU/L and 250 IU/L, respectively, with 95% specificity. There was no mortality in both groups. Conclusion: Liver transaminases can be used effectively in eliminating unnecessary use of CT. This allows for cost-effective use of resources, and eliminates the risks of radiation.

Life-threatening complications and mortality of minimally invasive pectus surgery.

Data related to life-threatening complications of Pectus Excavatum (PE) patients was obtained from four sources: 1. A survey of Chest Wall International Group (CWIG) surgeons who specialize in repairing congenital chest wall malformations, 2. Papers and case reports presented at CWIG meetings, 3. Review of medico-legal cases from the USA and 4. A systematic review of the literature related to major complications post MIRPE. From 1998 to 2016, we identified 27 published cases and 32 unreported life-threatening complications including: cardiac perforation, hemothorax, major vessel injury, lung injury, liver injury, gastrointestinal problems, and diaphragm injury. There were seven cases of major complications with bar removal (reported and non-reported) with two lethal outcomes. Mortality data with bar placement surgery: Four published death cases and seven unpublished death cases. The overall incidence of minor & major complications post MIRPE has been reported in the literature to be 2-20%. The true incidence of life-threatening complications and mortality is not known as we do not know the overall number of procedures performed worldwide. However, based on data extrapolated from survey information, the pectus bar manufacturer in the USA, literature reports, and data presented at CWIG meetings as to the number of cases performed we estimated that approximately fifty thousand cases have been performed and that the incidence of life-threatening complications is less than 0.1% with many occurring during the learning curve. Analysis of the cases identified in our survey revealed that previous chest surgery, pectus severity and inexperience were noted to be significant risk factors for mortality. Published reports support the safety and efficacy of MIRPE; however major adverse outcomes are underreported. Although major complications with MIRPE and pectus bar removal surgery are very rare, awareness of the risk and mortality of life-threatening complications is essential to ensure optimal safety. Factors such as operative technique, patient age, pectus severity and asymmetry, previous chest surgery, and the surgeon's experience play a role in the overall incidence of such events. These preventable events can be avoided with proper training, mentoring, and the use of sternal elevation techniques. Treatment Study. Level IV.

Traumatic Intraparenchymal Pseudoaneurysm on Initial Imaging Predicts Injury Progression in Patients with Nonoperative Major Blunt Liver Injury

Most patients who present with hemodynamic stability and no evidence of peritonitis after blunt liver injury are successfully managed nonoperatively. Little information is available regarding the utility of reimaging major blunt liver injuries for patients who are managed nonoperatively. A retrospective review of patients admitted to a level I trauma center with major blunt liver injuries (AAST grades 3–5) was conducted. Inclusion criteria were those admitted from July 2012 to June 2014 with blunt liver trauma who survived the first 24 hours and underwent repeat imaging. Data included demographics, procedures performed, and computerized tomography (CT) scan findings. Findings on the second CT scan were categorized as Unchanged, Worse, Improved, or Negative. A total of 128 patients had blunt major liver injuries; 66 patients underwent repeat imaging. The mean time to repeat CT was 1.95 days. On repeat CT, 47 were Unchanged, 3 Worse, 14 Improved, and 2 Negative. Three patients underwent angiography. One required embolization of a pseudoaneurysm. In 63 patients (95%), the second CT did not change the management plan. The presence of a pseudoaneurysm was significantly related to a worsening of the second CT (P = 0.0475). Patients with admission hematocrit (Hct) below 32% were more likely to have a worsened second CT (P = 0.0370). A pseudoaneurysm on admission CT and Hct &amp;lt;32% predict major liver injury progression suggesting that routine reimaging is warranted in this group.

Generation of a Humanized Mouse Liver Using Human Hepatic Stem Cells.

A novel animal model involving chimeric mice with humanized livers established via human hepatocyte transplantation has been developed. These mice, in which the liver has been repopulated with functional human hepatocytes, could serve as a useful tool for investigating human hepatic cell biology, drug metabolism, and other preclinical applications. One of the key factors required for successful transplantation of human hepatocytes into mice is the elimination of the endogenous hepatocytes to prevent competition with the human cells and provide a suitable space and microenvironment for promoting human donor cell expansion and differentiation. To date, two major liver injury mouse models utilizing fumarylacetoacetate hydrolase (Fah) and uroplasminogen activator (uPA) mice have been established. However, Fah mice are used mainly with mature hepatocytes and the application of the uPA model is limited by decreased breeding. To overcome these limitations, Alb-toxin receptor mediated cell knockout (TRECK)/SCID mice were used for in vivo differentiation of immature human hepatocytes and humanized liver generation. Human hepatic stem cells (HpSCs) successfully repopulated the livers of Alb-TRECK/SCID mice that had developed lethal fulminant hepatic failure following diphtheria toxin (DT) treatment. This model of a humanized liver in Alb-TRECK/SCID mice will have functional applications in studies involving drug metabolism and drug-drug interactions and will promote other in vivo and in vitro studies.

Penetrating Liver Injuries

Injuries to the liver are common. In the past, virtually, all penetrating injuries to the liver were managed by laparotomy, direct surgical exploration of the injured liver and repair. However, stable patients with isolated liver injuries, particularly those with low grade injuries, are now able to be managed non-operatively. Operative management can be as simple as packing, suture repair, and/or application of topical hemostatics. More complicated repairs such as resectional debridement, finger fracture with direct ligation of bleeding vessels, and major non-anatomic liver resections are sometimes needed to obtain hemostasis in major liver injuries. Damage control surgical techniques seem ideally suited for major liver injuries. Hemostasis is obtained with packing and whatever other techniques are necessary. This is used as a bridge to angiographic embolization, which can be followed by unpacking and other operative therapy as needed when the patient is more stable. Minimally invasive techniques, such as laparoscopy, do not have a major role in the management of penetrating liver injuries, though that may be expanded as time goes on. Newer adjuncts for hemostasis, such as higher quality topical hemostatic bandages, as well as other innovative therapies, may soon become available. Hepatic failure is infrequent, even with major liver injury, but extracorporeal techniques can be used in the few cases where profound hepatic failure does occur.

Predictive factors for early failure of transarterial embolization in blunt hepatic injury patients

To evaluate the early success of transarterial embolization (TAE) in patients with traumatic liver haemorrhage and to determine independent factors for its failure. From January 2009 to December 2012, TAE was performed in 48 patients for traumatic liver haemorrhage. Their medical charts were reviewed for demographic information, pre-TAE vital signs and laboratory data, injury grade, type of contrast medium extravasation (CME) at CT, angiography findings, and early failure. "Early failure" was defined as the need for repeated TAE or a laparotomy for hepatic haemorrhage within 4 days after TAE. Variables were compared between the early success and early failure groups. Variables with univariate significance were also analysed using multivariate logistic regression for predictors of early failure. Among 48 liver TAE cases, nine (18.8%) were early failures due to liver haemorrhage. Early failure was associated with injury grade (p = 0.039), major liver injury (grades 4 and 5; p = 0.007), multiple CMEs at angiography (p = 0.031), incomplete TAE (p = 0.002), and elevated heart rate (p = 0.026). Incomplete embolization (OR = 8; p = 0.042), and heart rate >110 beats/min (bpm; OR = 8; p = 0.05) were independent factors for early failure of TAE in the group with major liver injuries. Major hepatic injury is an important factor in early failure. Patients with a heart rate >110 bpm and incomplete embolization in the major injury group have an increased rate of early failure. The success rate of proximal TAE was comparable to that of the more time-consuming, superselective, distal TAE.

A protocol for a scoping and qualitative study to identify and evaluate indications for damage control surgery and damage control interventions in civilian trauma patients

IntroductionInitial abbreviated surgery with planned reoperation (damage control surgery) is frequently used for major trauma patients to rapidly control haemorrhage while limiting surgical stress. Although damage control surgery may decrease...

Surgical management and outcome of blunt major liver injuries: Experience of damage control laparotomy with perihepatic packing in one trauma centre

IntroductionThis retrospective study aimed to assess the clinical experience and outcome of damage control laparotomy with perihepatic packing in the management of blunt major liver injuries. Materials and methodsFrom January 1998 to December 2006, 58 patients of blunt major liver injury, American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) equal or greater than III, were operated with perihepatic packing at our institute. Demographic data, intra-operative findings, operative procedures, adjunctive managements and outcome were reviewed. To determine whether there was statistical difference between the survivor and non-survivor groups, data were compared by using Mann–Whitney U test for continuous variables, either Pearson's chi-square test or with Yates continuity correction for contingency tables, and results were considered statistically significant if p<0.05. ResultsOf the 58 patients, 20 (35%) were classified as AAST-OIS grade III, 24 (41%) as grade IV, and 14 (24%) as grade V. At laparotomy, depending on the severity of injuries, all 58 patients underwent various liver-related procedures and perihepatic packing. The more frequent liver-related procedures included debridement hepatectomy (n=21), hepatorrhaphy (n=19), selective hepatic artery ligation (n=11) and 7 patients required post-laparotomy hepatic transarterial embolization. Of the 58 patients, 28 survived and 30 died with a 52% mortality rate. Of the 30 deaths, uncontrolled liver bleeding in 24-h caused 25 deaths and delayed sepsis caused residual 5 deaths. The mortality rate versus OIS was grade III: 30% (6/20), grade IV: 54% (13/24), and grade V: 79% (11/14), respectively. On univariate analysis, the significant predictors of mortality were OIS grade (p=0.019), prolonged initial prothrombin time (PT) (p=0.004), active partial thromboplastin time (APTT) (p<0.0001) and decreased platelet count (p=0.005). ConclusionsThe mortality rate of surgical blunt major liver injuries remains high even with perihepatic packing. Since prolonged initial PT, APTT and decreased platelet count were associated with high risk of mortality, we advocate combination of damage control resuscitation with damage control laparotomy in these major liver injuries.

Activation of serotonin receptor-2B rescues small-for-size liver graft failure in mice

The implantation of grafts below 30% of the normal liver volume is associated with a high risk of failure known as small-for-size (SFS) syndrome. Strategies to rescue small grafts may have a dramatic impact on organ shortage. Serotonin is a potent growth factor for the liver. The goal of this study was to determine whether enhanced serotonin signaling could prevent the deleterious effects of SFS syndrome. We performed 30% normal liver volume transplantations in wild-type C57/BL6 and interleukin-6 (IL-6)(-/-) mice. Some animals received α-methyl-5-HT (DOI), an agonist of serotonin receptor-2 (5-HT2B). Endpoints included long-term survival, serum and hepatic markers of liver injury and regeneration, assessment of hepatic microcirculation by intravital fluorescence microscopy and scanning electron microscopy, and transcript levels of a variety of serotonin receptors, tumor necrosis factor α, and IL-6. All recipients of small grafts (controls) died within 2-4 days of transplantation, whereas half of those receiving DOI survived permanently. Control animals disclosed major liver injury, including diffuse microvesicular steatosis in hepatocytes, impairment of microcirculation, and a failure of regeneration, whereas these parameters were dramatically improved in animals subjected to DOI. Blockage of 5-HT2B blunted the protective effects of DOI. Whereas IL-6 levels were higher in DOI-treated animals, IL-6(-/-) mice were still protected by DOI, suggesting a protective pathway independent of IL-6. Serotonin through its action on receptor-2B protects SFS liver grafts from injury and prevents microcirculation and regeneration. The mechanism of hepato-protection is independent of IL-6.

Chitosan arrests bleeding in major hepatic injuries with clotting dysfunction: an in vivo experimental study in a model of hepatic injury in the presence of moderate systemic heparinisation

The purpose of this study was to explore the effectiveness of two chitosan formulations, Omni-Stat® granules and Celox Gauze®, in a model of major hepatic injury in the presence of clotting dysfunction. Major hepatic injuries in moderately heparinised swine were treated with either Omni-Stat® granules or Celox Gauze® as compared to control plain gauze. Plain gauze control failed to stop the bleeding in 13 of 14 attempts. Omni-Stat® arrested the bleeding in 18 of 18 attempts, providing it was in contact with the bleeding surface. Celox Gauze® arrested bleeding in 5 out of 6 attempts initially, and with further pressure in the sixth. The results support the evidence that chitosan-derived products act independently of classical clotting pathways and should be effective in patients who suffer major liver injury even in the presence of clotting dysfunctions.

Hepatitis B virus as a gene delivery vector activating foreign antigenic T cell response that abrogates viral expression in mouse models #

Chronic hepatitis B virus (HBV) infection is characterized by functionally impaired T cell responses. To ensure active immunotherapy, the immune response must be switched from exhausted T cells to functional effectors that can attain the liver and cure the viral infection. We thus designed a recombinant HBV (rHBV) containing a modified viral core gene that specifically delivers a foreign antigenic polyepitope to the liver. This recombinant virus could only be self-maintained in hepatocytes already infected by HBV through capsid complementation. A strong foreign epitope-specific T cell response was first primed in the periphery by way of DNA immunization in human leukocyte antigen (HLA)-A2/DR1 transgenic mice. After the hydrodynamic (hyd.) injection of rHBV, expression of the foreign antigenic polyepitope in hepatocytes attracted/reactivated a vigorous T cell response in situ. Most liver-infiltrating CD8(+) T cells proved to be functional effectors. Following DNA priming and hyd. injection, the rHBV-based expression of hepatitis B surface antigen (HBsAg) in mouse liver was almost completely inhibited without causing major liver injury. Studies in HBsAg/HLA-A2/DR1 transgenic mice further validated our approach. For the first time, HBV was used as a gene delivery vector, which strongly triggered functional T cell response and subsequently controlled the viral expression in the liver of surrogate mouse models for HBV infection. It might represent an innovative and promising strategy of active immunotherapy during HBV persistent infection. This concept could even be more generally extended to other chronic viral diseases.

Cardiopulmonary resuscitation-associated major liver injury

To evaluate the frequency, presentation, treatment and outcome of cardiopulmonary resuscitation-associated major liver injury in patients after non-traumatic in- or out-of-hospital cardiac arrest. Retrospective analysis of a cardiac arrest registry in a tertiary care hospital emergency department. We reviewed patients charts, laboratory data, diagnostic imaging studies and autoptic findings. Within 14.5 years, major liver injury (rupture/laceration, haemorrhage/haematoma) was found in 15 of 2558 cardiac arrest victims (0.6%). Eleven were male (73%), median age was 58 (IQR 53-67). In seven, resuscitation was started out-of-hospital. In 9 of the 15 patients, liver injury was correctly diagnosed intra vitam. In 5, haematocrit level was low on admission, in 8 haematocrit dropped significantly during observation; haemostasis was compromised in 13 patients, 4 of them receiving thrombolytic therapy. Bedside abdominal sonography showed free intra-peritoneal fluid in 8 of 9 cases examined. In 11 patients, we found liver rupture/laceration, in 4 liver haemorrhage/haematoma. The site of injury was the left liver lobe in 11, six underwent emergent surgery. Two of 15 patients survived to 6 months in good neurological condition, 1 after emergency surgery. No patient died from bleeding due to liver injury. Our single centre observation confirms that resuscitation-associated major liver injury is infrequent and shows that most patients had compromised haemostasis. Low or dropping haematocrit should trigger suspicion. Bedside sonography reveals intra-peritoneal fluid or liver injury. A conservative therapeutic approach or emergency surgery may be warranted. Major liver injury alone scarcely appears to influence overall outcome.

Major Blunt Liver Injury with Contrast Pooling and Abdominal Compartment Syndrome: Report of a Case

The abdominal compartment syndrome (ACS), broadly defined as organ dysfunction due to intra-abdominal pressure beyond some cut-off point, can occur in patients with severe blunt abdominal solid organ injury with massive hemoperitoneum. Here, we report a 20-year-old man sustaining major liver laceration with contrast extravasation and massive hemoperitoneum. He subsequently developed ACS and was successfully treated with angioembolization and needle paracentesis. We suggest that bed-side ultrasonography and needle paracentesis be considered as an expedient alternative for decompression of intra-abdominal hypertension in patients with blunt solid visceral organ injury with massive hemoperitoneum and ACS.

Delayed hepatic resection for major liver injury.

Seven patients with major liver injury initially assessed and managed elsewhere, and then referred to the Hepatobiliary Unit at Hammersmith Hospital, London, are reported. Six of the 7 patients had been operated upon and 4 had undergone two laparotomies before referral. All were seriously ill as a result of bleeding or liver necrosis and infection. Further laparotomy was carried out for the control bleeding, débridement of dead tissue and drainage of infected material. Hepatic resection was performed in all patients and 3 of the 7 died in the postoperative period. Liver resection is necessary for the control of bleeding and removal of dead tissue in severe shattering injuries. Should temporary packing be instituted in order to obtain control, then early referral for definitive treatment is necessary. Delay is dangerous and extension of necrosis with secondary infection is inevitable.

The importance of radiologic and minimally invasive adjuncts in the nonoperative management of major penetrating liver injury

The importance of radiologic and minimally invasive adjuncts in the nonoperative management of major penetrating liver injury

LIPID AND CARBOHYDRATE METABOLISM, AND ANTIOXIDANT STATUS IN CHILDREN AFTER LIVER TRANSPLANTATION

Organ transplantation is a risk factor of atherogenesis that may be related to immune suppression therapy. Increased free radical generation may even aggrevate atherogenesis. The aim of the study was to assess lipid metabolism in relation to risk factors of atherogenesis as well as carbohydrate metabolism and antioxidant status in children after liver transplantation. Material: We investigated 35 children 3-5 y after liver transplantation aged 10.6 ± 4.7. We did not observe major liver injury in the patients studied (normal bilirubin and INR). Results: 95% conf. interval of total cholesterol (150-191 mg/dl), LDL-C (83-111 mg/dl), VLDL-C (12-18 mg/dl), HDL-C (44-54 mg/dl), apo AI (1.27-1.49 g/l), apo B (0.6-0.89 g/l), alpha-tocopherol (7.8-8.83 μg/ml) serum concentrations were within the normal limits. GSH was decreased in transplanted children when compared to 28 aged matched healthy controls (527.6-606.6 μmol/ml vs. 667.5-763.5), whereas GPx activity was similar in the study and control group (28.3-32.8 U/gHb vs. 30.6-34.5). Kruskall Wallis analysis in subgroups of children treated with cyclosporine (Cs) only (n = 8), tacrolimus (Tac) only (n = 12) and mycophenolate mofetil (MMF; n = 8) showed differences only in total cholesterol (Cs: 131.6-285.6; Tac: 144.0-181.6l; MMF: 132.1-181.2) and LDL-C (Cs: 79.4-126.9; Tac: 42.2-118.8; MMF: 74.2-117.3). Conclusion: Lipid metabolism is not significantly disturbed in children after liver transplantation that does not point to the high risk of atherogenesis. Cyclosporine seems to have the strongest untoward effect on cholesterol metabolism. GSH concentration is decreased after liver transplantation that may be related to slightly impaired liver function, but GPx activity and alpha-tocopherol concentration remain normal.