Table of ContentsView AllTable of ContentsSymptomsLiver DiseasesLiver Problems From MedicationsDiseases of Other SystemsDiagnosisTreatmentFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Symptoms
Liver Diseases
Liver Problems From Medications
Diseases of Other Systems
Diagnosis
Treatment
Frequently Asked Questions
Two enzymes may be elevated:aspartate transaminase (AST)or alanine transaminase (ALT). When one of these enzymes is elevated, it might be a sign of liver disease or another medical condition.
Transaminitis is also called hypertransaminasemia, transaminase elevation, or elevated liver enzymes.
In the general population, the number of people with elevated liver enzyme levels might be 10% or higher. However, only 5% or less of these people have a serious problem with theirliver.
This article will go over what you should know if your blood test shows transaminitis, including the possible causes and treatment.
Verywell / Gary Ferster
Elevated transaminase enzymes may be an indicator of medical conditions that can cause certain symptoms. These might include:
However, in many cases, people have elevated transaminase enzymes without having any symptoms. This may be especially likely if the elevations in these enzymes are not severe.
Liver Function
It also plays important roles in making certain proteins, including ones used for blood clotting and for fluid management in the body.
Damage to the liver can cause many different symptoms and problems.
Transaminases
Transaminases are a type of enzyme important for the synthesis of amino acids (the building blocks of protein). They are also called aminotransferases. Usually, the term “transaminase” is used to refer to the enzymes AST and ALT.
These enzymes can be found in the liver, but also to a lesser extent in other organs, such as the skeletal muscles, heart, and kidneys (particularly AST).
Liver Diseases That Cause Transaminitis
A number of different medical conditions can cause minor or major liver damage. This causes the release of AST and ALT into the bloodstream, causing elevated levels to show up on blood tests. Some of these potential causes include metabolic dysfunction-associated steatotic liver disease (MASLD, formerly known as NAFLD), alcoholic liver disease, liver infection (such as from hepatitis B or C), autoimmune disorders (like autoimmune hepatitis or primary biliary cholangitis), and rare genetic diseases like Wilson’s disease, hereditary hemochromatosis, or alpha-1 antitrypsin deficiency.
In the United States, the most common cause of mildly elevated transaminase levels ismetabolic dysfunction-associated steatotic liver disease(MASLD).
MASLD is associated with metabolic syndrome, elevated triglycerides, low HDL cholesterol, high blood pressure, increased waist circumference, obesity, and insulin resistance (such as in pre-diabetes or type 2 diabetes).
Transaminases might also be elevated as a reaction to certain medications. This might be particularly likely if a person is taking more than one medication that might damage the liver. Some common medications that sometimes cause elevations in transaminases include:
Medical conditions that affect other parts of the body can also sometimes cause elevated transaminases. (This is particularly true of elevations of AST as opposed to ALT). Some of these problems include:
Elevated levels of transaminases are found from blood tests for ALT and AST. If your AST and ALT are elevated, you might be told that you have transaminitis. You also might be told that you have elevated liver function tests (LFTs).Liver functiontests include not just AST and ALT, but other tests such as albumin and bilirubin, and alkaline phosphatase.
These can give other information about how the liver and other organs might be functioning. These tests are often performed as part of the medical diagnosis for a number of different problems. Sometimes, people learn that they have elevated liver enzymes even when they haven’t noticed troublesome symptoms.
If you have elevated transaminases, your healthcare provider will want to contextualize this with your overall health. The ratio of AST and ALT can give an indication of what type of problem might be going on. The amount of elevation is also an important diagnostic clue. For example, very high levels of transaminases likely indicate more severe, recent liver damage.
Medical history and exams are also important to consider. These can help your healthcare provider gain clues about the potential causes of your elevated transaminases. For example, it’s important that your healthcare provider ask you about your alcohol intake and your medications. Your healthcare provider will also examine you for any signs of liver disease (or that of other organ systems).
Additional medical tests may also be needed. Depending on the situation, these might include additional liver function blood tests, INR (International normalized ratio) blood test, acomplete blood count(CBC), iron and hepatitis tests, as well as tests for triglycerides, total cholesterol, a glucose A1C test, and/or additional tests for non-liver causes (like thyroid tests).
If transaminase levels don’t go down with treatment, follow up tests might be needed. These might include:
In difficult-to-diagnosis situations, a referral to a gastroenterologist may be helpful.
Diagnosis Caveats
Additionally, sometimes people may have severe liver damage but not necessarily elevated transaminases. High levels of AST and ALT usually indicate significant ongoing damage to the liver. But a person with severe liver disease might have had previous damage to the liver without showing a currently elevated AST or ALT. In this case, other tests can help fill out the clinical picture.
Elevated transaminases may indicate that you need treatment of some sort. This will depend on the underlying cause and its severity. People with symptoms of liver disease along with elevated transaminases may need more prompt interventions.
For example, if your healthcare provider suspects MASLD, lifestyle interventions are usually the first recommended treatment. This might include losing weight, avoiding foods that contain fructose, engaging in rigorous physical exercise, and limiting alcohol intake.Depending on the situation, other treatments might include antiviral treatments for viralhepatitisor stopping a drug causing liver damage.
You may need repeat AST, ALT, and other liver function tests after you start your treatment. This can help show how well you are responding to the treatment. Sometimes these tests reveal that mildly elevated levels of transaminases have gone down, even without treatment.
Taking Steps to Stop Liver DiseaseIf you do have a type of liver disease, it’s important to halt the progression of liver damage. Even if you don’t have symptoms now, your liver might be becoming gradually more damaged over time.
Taking Steps to Stop Liver Disease
If you do have a type of liver disease, it’s important to halt the progression of liver damage. Even if you don’t have symptoms now, your liver might be becoming gradually more damaged over time.
Eventually, this might cause life-threatening liver failure. Taking steps now may help you prevent long-term problems.
A Word From Verywell
You might be alarmed if you’ve been told you have transaminitis or elevated liver tests. It might be especially surprising if you had no idea that your liver could be at risk. However, try not to panic. Your healthcare provider will probably need to find out more to let you know what is going on. In most cases, your healthcare provider will be able to work with you to help protect your liver and your future health. Don’t hesitate to ask if you have any questions about possible diagnosis or treatment.
Symptoms of elevated liver enzymes may include abdominal pain or swelling, excess bleeding due to poor blood clotting, fatigue, itchy skin, leg and ankle swelling, nausea or vomiting, and yellowed skin (jaundice).The occurrence of symptoms will depend on the underlying medical condition as well as the severity of enzyme elevation.
Symptoms of elevated liver enzymes may include abdominal pain or swelling, excess bleeding due to poor blood clotting, fatigue, itchy skin, leg and ankle swelling, nausea or vomiting, and yellowed skin (jaundice).
The occurrence of symptoms will depend on the underlying medical condition as well as the severity of enzyme elevation.
Learn MoreUnderstanding Common Blood Tests and What They Mean
Elevated liver enzymes are thought to occur in a median of 15% of COVID patients and possibly up to 58% of COVID patients.However, one study concluded that elevated liver enzymes didn’t affect disease severity or outcome for hospitalized COVID patients.
Elevated liver enzymes are thought to occur in a median of 15% of COVID patients and possibly up to 58% of COVID patients.
However, one study concluded that elevated liver enzymes didn’t affect disease severity or outcome for hospitalized COVID patients.
13 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Stellpflug SJ.Transaminitis: the lab test that has inflammation.J Med Toxicol. 2011;7(3):252-3. doi:10.1007/s13181-011-0161-7Radcke S, Dillon JF, Murray AL.A systematic review of the prevalence of mildly abnormal liver function tests and associated health outcomes.Eur J Gastroenterol Hepatol. 2015;27(1):1-7. doi:10.1097/MEG.0000000000000233Shah NJ, John S.Acute and chronic liver failure. In: StatPearls.Testing.com.Alanine aminotransferase (ALT).Oh RC, Hustead TR, Ali SM, Pantsari MW.Mildly elevated liver transaminase levels: causes and evaluation.Am Fam Physician. 2017;96(11):709-715.Malakouti M, Kataria A, Ali S, Schenker S.Elevated liver enzymes in asymptomatic patients – what should I do?J Clin Transl Hepatol. 2017;5(4):1-10. doi:10.14218/jcth.2017.00027Kibirige D, Kiggundu DS, Sanya R, Mutebi E.Cholestatic hepatic injury due to a thyroid storm: a case report from a resource limited setting.Thyroid Res. 2012;5(1):6. doi:10.1186/1756-6614-5-6Al-Busafi SA, Hilzenrat N.Mild hypertransaminasemia in primary care.ISRN Hepatol. 2013;2013:256426. doi:10.1155/2013/256426Romero-Gómez M, Zelber-Sagi S, Trenell M.Treatment of NAFLD with diet, physical activity and exercise.J Hepatol. 2017;67(4):829-846. doi:10.1016/j.jhep.2017.05.016Oh RC, Hustead TR, Ali SM, Pantsari MW.Mildly elevated liver transaminase levels: causes and evaluation.Am Fam Physician.MedlinePlus.Liver function tests.Moon A, Barritt A.Elevated liver enzymes in patients with COVID-19: look, but not too hard.Dig Dis Sci. 2020;66(6):1767-1769. doi:10.1007/s10620-020-06585-9Hao S, Zhang S, Lian J, et al.Liver enzyme elevation in coronavirus disease 2019: A multicenter, retrospective, cross-sectional study.American Journal of Gastroenterology. 2020;115(7):1075-1083. doi:10.14309/ajg.0000000000000717
13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Stellpflug SJ.Transaminitis: the lab test that has inflammation.J Med Toxicol. 2011;7(3):252-3. doi:10.1007/s13181-011-0161-7Radcke S, Dillon JF, Murray AL.A systematic review of the prevalence of mildly abnormal liver function tests and associated health outcomes.Eur J Gastroenterol Hepatol. 2015;27(1):1-7. doi:10.1097/MEG.0000000000000233Shah NJ, John S.Acute and chronic liver failure. In: StatPearls.Testing.com.Alanine aminotransferase (ALT).Oh RC, Hustead TR, Ali SM, Pantsari MW.Mildly elevated liver transaminase levels: causes and evaluation.Am Fam Physician. 2017;96(11):709-715.Malakouti M, Kataria A, Ali S, Schenker S.Elevated liver enzymes in asymptomatic patients – what should I do?J Clin Transl Hepatol. 2017;5(4):1-10. doi:10.14218/jcth.2017.00027Kibirige D, Kiggundu DS, Sanya R, Mutebi E.Cholestatic hepatic injury due to a thyroid storm: a case report from a resource limited setting.Thyroid Res. 2012;5(1):6. doi:10.1186/1756-6614-5-6Al-Busafi SA, Hilzenrat N.Mild hypertransaminasemia in primary care.ISRN Hepatol. 2013;2013:256426. doi:10.1155/2013/256426Romero-Gómez M, Zelber-Sagi S, Trenell M.Treatment of NAFLD with diet, physical activity and exercise.J Hepatol. 2017;67(4):829-846. doi:10.1016/j.jhep.2017.05.016Oh RC, Hustead TR, Ali SM, Pantsari MW.Mildly elevated liver transaminase levels: causes and evaluation.Am Fam Physician.MedlinePlus.Liver function tests.Moon A, Barritt A.Elevated liver enzymes in patients with COVID-19: look, but not too hard.Dig Dis Sci. 2020;66(6):1767-1769. doi:10.1007/s10620-020-06585-9Hao S, Zhang S, Lian J, et al.Liver enzyme elevation in coronavirus disease 2019: A multicenter, retrospective, cross-sectional study.American Journal of Gastroenterology. 2020;115(7):1075-1083. doi:10.14309/ajg.0000000000000717
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Stellpflug SJ.Transaminitis: the lab test that has inflammation.J Med Toxicol. 2011;7(3):252-3. doi:10.1007/s13181-011-0161-7Radcke S, Dillon JF, Murray AL.A systematic review of the prevalence of mildly abnormal liver function tests and associated health outcomes.Eur J Gastroenterol Hepatol. 2015;27(1):1-7. doi:10.1097/MEG.0000000000000233Shah NJ, John S.Acute and chronic liver failure. In: StatPearls.Testing.com.Alanine aminotransferase (ALT).Oh RC, Hustead TR, Ali SM, Pantsari MW.Mildly elevated liver transaminase levels: causes and evaluation.Am Fam Physician. 2017;96(11):709-715.Malakouti M, Kataria A, Ali S, Schenker S.Elevated liver enzymes in asymptomatic patients – what should I do?J Clin Transl Hepatol. 2017;5(4):1-10. doi:10.14218/jcth.2017.00027Kibirige D, Kiggundu DS, Sanya R, Mutebi E.Cholestatic hepatic injury due to a thyroid storm: a case report from a resource limited setting.Thyroid Res. 2012;5(1):6. doi:10.1186/1756-6614-5-6Al-Busafi SA, Hilzenrat N.Mild hypertransaminasemia in primary care.ISRN Hepatol. 2013;2013:256426. doi:10.1155/2013/256426Romero-Gómez M, Zelber-Sagi S, Trenell M.Treatment of NAFLD with diet, physical activity and exercise.J Hepatol. 2017;67(4):829-846. doi:10.1016/j.jhep.2017.05.016Oh RC, Hustead TR, Ali SM, Pantsari MW.Mildly elevated liver transaminase levels: causes and evaluation.Am Fam Physician.MedlinePlus.Liver function tests.Moon A, Barritt A.Elevated liver enzymes in patients with COVID-19: look, but not too hard.Dig Dis Sci. 2020;66(6):1767-1769. doi:10.1007/s10620-020-06585-9Hao S, Zhang S, Lian J, et al.Liver enzyme elevation in coronavirus disease 2019: A multicenter, retrospective, cross-sectional study.American Journal of Gastroenterology. 2020;115(7):1075-1083. doi:10.14309/ajg.0000000000000717
Stellpflug SJ.Transaminitis: the lab test that has inflammation.J Med Toxicol. 2011;7(3):252-3. doi:10.1007/s13181-011-0161-7
Radcke S, Dillon JF, Murray AL.A systematic review of the prevalence of mildly abnormal liver function tests and associated health outcomes.Eur J Gastroenterol Hepatol. 2015;27(1):1-7. doi:10.1097/MEG.0000000000000233
Shah NJ, John S.Acute and chronic liver failure. In: StatPearls.
Testing.com.Alanine aminotransferase (ALT).
Oh RC, Hustead TR, Ali SM, Pantsari MW.Mildly elevated liver transaminase levels: causes and evaluation.Am Fam Physician. 2017;96(11):709-715.
Malakouti M, Kataria A, Ali S, Schenker S.Elevated liver enzymes in asymptomatic patients – what should I do?J Clin Transl Hepatol. 2017;5(4):1-10. doi:10.14218/jcth.2017.00027
Kibirige D, Kiggundu DS, Sanya R, Mutebi E.Cholestatic hepatic injury due to a thyroid storm: a case report from a resource limited setting.Thyroid Res. 2012;5(1):6. doi:10.1186/1756-6614-5-6
Al-Busafi SA, Hilzenrat N.Mild hypertransaminasemia in primary care.ISRN Hepatol. 2013;2013:256426. doi:10.1155/2013/256426
Romero-Gómez M, Zelber-Sagi S, Trenell M.Treatment of NAFLD with diet, physical activity and exercise.J Hepatol. 2017;67(4):829-846. doi:10.1016/j.jhep.2017.05.016
Oh RC, Hustead TR, Ali SM, Pantsari MW.Mildly elevated liver transaminase levels: causes and evaluation.Am Fam Physician.
MedlinePlus.Liver function tests.
Moon A, Barritt A.Elevated liver enzymes in patients with COVID-19: look, but not too hard.Dig Dis Sci. 2020;66(6):1767-1769. doi:10.1007/s10620-020-06585-9
Hao S, Zhang S, Lian J, et al.Liver enzyme elevation in coronavirus disease 2019: A multicenter, retrospective, cross-sectional study.American Journal of Gastroenterology. 2020;115(7):1075-1083. doi:10.14309/ajg.0000000000000717
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