Background: Accurate diagnosis of fatty LIVER is crucial for prognosis and treatment planning.Objectives: This study aimed to correlate LIVER fibroscan results with shear wave elastography and LIVER enzyme levels in fatty LIVER patients. Methods: In a cross-sectional study, 80 fatty LIVER patients from Shahid Motahari Clinic in Shiraz was examined over six months. Diagnoses were made using fibroscan (Echosense 500) and CAP scores, while the Hepatorenal Index was measured with shear wave elastography (Sypersonic, Aixplorer elit). Previous sonography reports were collected for correlation. Results: Patients’ average age was 50.91 years so that 45% were men, and 55% were women. About 78.8% diagnosed with fatty LIVER by ultrasound were also diagnosed by elastography (true positive). A weak, non-significant positive correlation was observed between the Ratio and CAP score (r = 0.18, P = 0.87). ALT predicted fatty LIVER by elastography with 83.6% sensitivity and 64.7% specificity. Few studies in Iran have explored elastography and fibroscan correlation in fatty LIVER. Conclusions: Shear wave elastography is a valuable non-invasive technique for predicting fatty LIVER.

A 22-year-old woman, known case of autoimmune hepatitis, underwent LIVER transplantation. She discharged from the hospital in good condition. After 50 days, she presented with abnormal LIVER enzyme (ALT=117 IU/L, AST=167 IU/L). Laboratory investigation showed positive IgM anti-CMV antibody. Anti-VCA (EBV) IgM was negative. LIVER biopsy was performed (Fig 1). All the bacterial and fungal cultures were negative.

Background: LIVER ENZYMES elevations (LEE) can be observed after kidney transplantation due to multifactorial causes.Objectives: We performed a retrospective study on 1589 kidney transplants, 971 male and 618 female, who were hepatitis B surface antigen (HBsAg) and hepatitis C virus-antibody (HCV Ab) negative, and had no other LIVER diseases, to detect the prevalence of LEE and its risk factors in these patients between May 2008 and May 2010.Patients and methods: LIVER ENZYMES and other biochemical parameters were measured in all recipients. Patients were divided into three groups, according to laboratory test time since transplantation: Group I, less than 3 months, Group II, 4 - 12 months after transplantation, and Group III, more than one year post-transplantation.Results: The highest LEE was more frequent in older patients (P<0.001) and male individuals (P<0.001). Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were higher in patients who received kidneys from deceased donors (10.4% and 23.8%, respectively) as compared to living donor transplants (5.6% and 14.8%, respectively) (P<0.001). The elevation of ALT was the LIVER enzyme abnormality after kidney transplantation with the highest prevalence (34.3%). The levels of ALT and AST were significantly elevated within the first 3 months after transplantation, followed by the 4-12 months period (P<0.001). There was a reverse correlation between LIVER enzyme levels and renal allograft function in both univariate and linear regression analyses. This correlation increased over time. There was also a significant relation between cyclosporine blood levels and LIVER enzyme values in the univariate analysis. However, this relationship was attenuated over time. Elevated LIVER ENZYMES also correlated with anemia.Conclusions: The LEE is a common finding among kidney transplant recipients. Serial monitoring of aminotransferases, particularly ALT, should be performed in all patients after kidney transplantation.

Background: Acute heart failure (AHF) is defined as the new onset or recurrence of gradual or rapidly worsening signs and symptoms of heart failure, requiring urgent or emergent therapy.Objectives: This study attempts to assess the association of LIVER function tests (LFT) and uric acid level with in hospital outcome and echocardiography parameters, in patients with acute decompensated heart failure.Patients and Methods: A total of 100 patients (aged 16-90 years, 60% men) admitted with AHF were enrolled. LFTs and uric acid levels were assessed on first day and before discharge, and patients were followed for 3 months.Results: In-hospital outcomes were considered. Mean Left Ventricular Ejection Fraction (LVEF) was 35% (20-45%). Mean Uric acid level was 8.4 mg/dL, significantly higher than chronic HF and normal groups (P<0.02). Elevated LIVER ENZYMES were seen in 52% patients, mostly (87%) in transaminases. LIVER ENZYMES were decreased in 85% patients before discharge. LFT and uric acid levels were inversely and significantly correlated with LVEF on echocardiography (P=0.02), but not with diastolic parameters. Although there was no significant correlation between uric acid level and in-hospital mortality, risk of intubation and rehospitalization in 3 months, enzyme levels increased in these groups. Increased aspartate transaminase (AST level) was associated with inotrope infusion in AHF patients (42 vs. 82 mg/dL, P=0.03).Conclusions: Abnormal transaminases and uric acid levels are seen in AHF patients. Increased AST levels may be a predictor of the need for inotrope during hospital course in these patients.