Unusual Early Post-Transplant Hepatic Dysfunction

A 61-year-old woman underwent liver transplantation from a brain-dead donor in February 2023 due to decompensated alcohol-related cirrhosis. The surgery was performed using the piggy-back technique with standard anastomoses, during which she required noradrenaline perfusion for haemodynamic instability, which was discontinued within the first 24 hours. The cold ischaemia time was 7.25 hours, and the warm ischaemia time was 53 minutes. The transaminase peak occurred on post-transplant Day 1 (alanine aminotransferase 832 IU/ml, aspartate aminotransferase 637 IU/ml, bilirubin 1.08 mg/dl, gamma glutamyltransferase 75 IU/ml, alkaline phosphatase 64 IU/ml). Initial immunosuppression included basiliximab, steroids, and mycophenolate mofetil, with tacrolimus introduced on the third post-transplant day.