From the Guidelines
Transaminitis is characterized by elevated levels of liver enzymes, specifically alanine transaminase (ALT) and aspartate transaminase (AST), in the bloodstream, indicating liver cell damage or inflammation, as noted in a 2023 study published in the Journal of the American College of Radiology 1. Transaminitis refers to this condition, which is not a disease itself, but rather a marker of liver damage. The severity of abnormal aminotransferase can be classified as mild, moderate, or severe, with moderate and severe being discussed collectively due to significant clinical overlap, as stated in the study 1. Some key points to consider about transaminitis include:
- Elevated ALT levels are specific for liver injury, with normal levels ranging from 19 to 25 IU/L in women and 29 to 33 IU/L in men, as reported in the study 1
- AST elevations can also occur due to disorders involving the heart, skeletal muscle, kidneys, brain, and red blood cells, making ALT a more specific indicator of liver damage 1
- Management of transaminitis focuses on treating the underlying cause, which may involve lifestyle changes, medication adjustments, or specific treatments for conditions like viral or autoimmune hepatitis, with regular monitoring of liver enzymes to track improvement 1.
From the Research
Definition of Transaminitis
- Transaminitis refers to inflammatory processes characterized by elevated alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase, also known as abnormal liver enzymes or abnormal liver chemistries 2.
- It is estimated that approximately 10% to 20% of the general population has elevated liver chemistry levels, including aspartate and alanine transaminases 3, 4, 5.
Causes of Transaminitis
- The most common causes of mildly elevated transaminase levels are metabolic dysfunction-associated steatotic liver disease (MASLD) and alcoholic liver disease 3, 4, 5.
- Uncommon causes include drug-induced liver injury, chronic hepatitis B and C, and hereditary hemochromatosis 3, 4, 5.
- Rare causes are alpha1-antitrypsin deficiency, autoimmune hepatitis, and Wilson disease 3, 4, 5.
- Extrahepatic causes are celiac disease, hyperthyroidism, rhabdomyolysis, and pregnancy-associated liver disease 3, 4, 5.
Evaluation of Transaminitis
- Initial laboratory testing assesses complete blood cell count with platelets, blood glucose, lipid profile, hepatitis B surface antigen, hepatitis C antibody, serum albumin, iron, total iron-binding capacity, and ferritin 3, 4, 5.
- If MASLD is suspected, the FIB-4 Index Score or NAFLD Fibrosis Score can be used to predict which patients are at risk for fibrosis and may benefit from further testing or referral to a hepatologist 3.
- A liver biopsy may be considered when serologic testing and imaging fails to elucidate a diagnosis, to stage a condition, or when multiple diagnoses are possible 6.