Liver transplant complications with no cause

Persistent elevated liver enzymes after liver transplant despite negative rejection biopsy — anyone similar?

I'm a long-term liver transplant recipient and I'm hoping to hear from other transplant patients who may have experienced something similar.

I've had persistently elevated liver enzymes. I also developed a significant biliary obstruction/stricture that required ERCPs and stenting. The obstruction has been treated and the stents are patent, but my liver enzymes have remained elevated.

A recent liver biopsy showed stage 2 of 4 periportal fibrosis and a subtle bile ductular reaction, but importantly it showed no acute cellular rejection, no autoimmune hepatitis, no significant steatosis/steatohepatitis, no cholestasis, no ductopenia, and no significant bile-duct injury. The cause of the fibrosis and persistent enzyme elevation remains unclear.

I'm currently on tacrolimus and have also been prescribed ursodiol. I previously tolerated CellCept (mycophenolate).

I'm particularly interested in hearing from anyone who:

- Had persistently elevated liver enzymes after transplant despite a biopsy that did not show rejection.
- Had chronic biliary strictures/obstruction followed by fibrosis or persistent abnormal liver tests even after the obstruction was corrected.
- Had a subtle immune-mediated problem that wasn't initially obvious on biopsy.
- Had CellCept/mycophenolate added to tacrolimus and subsequently saw their liver enzymes improve.
- Eventually discovered another explanation for unexplained liver-enzyme elevations.

I'm not looking to change medications based on forum advice—I'm discussing all treatment decisions with my transplant team. I'm mainly interested in hearing about other people's experiences and what ultimately helped their doctors determine the cause.

Has anyone gone through something similar?