Liver, the largest internal organ in the body has many complex functions. It acts as a filter of the blood received from the GI tract through the portal vein. It synthesizes proteins that are involved in vital functions and is an important site of carbohydrate, protein and lipid metabolism. It detoxifies toxins, metabolizes drugs and hormones, conjugates bilirubin and excretes it through the bile. Liver dysfunction, therefore, has catastrophic consequences on the body. Liver function tests comprise of a battery of tests that are used: a. as a tool for screening and documenting liver injury, to provide vital clues to the etiology of liver disease, to monitor the disease progression and response to treatment and to assess prognosis in children with liver failure. The liver function tests can be categorized into five: A. Tests to detect hepatocyte injury B. Tests to detect cholestasis or impaired bile flow C. Tests that assess synthetic function of liver D. Tests that assess metabolic and excretory function of liver E. Tests that assess liver fibrosis. Appropriate utilization of the tests requires knowledge of the injury patterns in liver diseases.1. Liver function tests must be interpreted in the context of a clinical diagnosis 2. These tests lack sensitivity and so normal results do not confirm absence of disease. 3. Liver function tests are useful in identifying the pattern of liver disease rather than arriving at an etiological diagnosis. 4. Age specific normal values have to be employed when interpreting lab tests like alkaline phosphatase, GGT and prothrombin time. 5. Gross elevation of transaminases occurs in primary hepatocellular diseases while ALP and GGT are very high in cholestatic diseases. 6. Increasnig bilirubin with falling transaminases denotes poor prognosis in acute severe failure.

Background: Patients with liver cirrhosis experience a hyperdynamic circulation. Objective: To investigate the association between early hemodynamic changes and graft function after liver transplant. Methods: Those patients who underwent liver transplantation in 2016 were enrolled in the study. Liver function indices measured in postoperative days (POD) 1, 3, 5, 7, 9, and 11 along with hemodynamic indices including pulse rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and central venous pressure (CVP) measured q6h in the first 3 days after transplantation were recorded. Results: 57 deceased-donor liver recipients with a mean± SD age of 41. 4± 11. 8 years including 33 (58%) males were enrolled in the study. The mean± SD aspartate and alanine aminotransferases, alkaline phosphatase, and lactate dehydrogenase were significantly decreased from 1879± 670. 5, 369. 2± 40. 5, 174. 9± 18. 8, and 1907. 6± 323. 1 U/L in POD 1 to 37. 2± 10. 7, 243. 4± 37. 3, 207. 5± 19. 5, and 382. 4± 59. 8 U/L in POD 3, respectively (p=0. 028, <0. 001, 0. 002, and 0. 001, respectively). During this period, the pulse rate of the patients was significantly (p<0. 001) decreased by a median (IQR) of 28. 7 (8. 5– 39. 7) beats/min; it was significantly correlated with a decrease in serum hepatic enzymes activities during this period. SBP, DBP, and CVP were significantly increased (p<0. 001 for all) during this period. Liver graft function improved significantly earlier in those patients with a mean pulse rate of 87 beats/min compared with others (p=0. 03). Conclusions: There may be an association between changes of hemodynamic indices, especially reduction of pulse rate, and improved graft function early after liver transplantation.