Transaminitis

What is transaminitis?

Transaminitis is high levels of a particular type of enzyme in your blood, called a transaminase. The most common ones are alanine transaminase (ALT) and aspartate transaminase (AST) (also called alanine transferase and aspartate transferase). These enzymes are released into your blood by your liver. If a blood test shows your transaminases are elevated, it suggests that your liver is under stress.

You might not have any other symptoms with transaminitis. Healthcare providers often discover it incidentally on a routine blood panel (comprehensive metabolic panel). If you do have symptoms that suggest liver stress, like jaundice and upper abdominal pain, your provider might give you specific blood tests to check how your liver is functioning. These tests measure transaminases and other things.

How is transaminitis different from other elevated liver enzymes?

Elevated transaminases are one of the earliest signs of liver stress, especially when both ALT and AST rise together. Damaged liver cells release these enzymes into your bloodstream. Transaminitis can indicate hepatitis (liver inflammation) before any other signs appear. Other liver enzymes, like alkaline phosphatase (ALP) and gamma-glutamyltransferase (GGT), are more suggestive of bile duct diseases.

Is transaminitis serious?

Transaminitis usually happens when cells in your liver tissues have been damaged. This is potentially serious, but context matters. Some causes of liver damage are brief, while others are ongoing. Your liver can recover from minor damage if it gets the chance. But ongoing or severe injury can overwhelm your liver, leading to liver failure. Transaminitis is just one factor in determining your overall condition.

What levels of transaminase are considered transaminitis?

Transaminitis isn’t a clinically defined value. But most labs that conduct blood tests have a defined “normal” range of transaminase levels. A healthcare provider might describe your levels as “transaminitis” if they’re significantly above the defined normal range for your age, sex and body mass. Whether the difference is “significant” or not is up to the healthcare provider’s interpretation.

Can transaminitis be mild or severe?

Your transaminase levels can be mildly elevated or severely elevated, although different healthcare providers might define these values differently. Severe transaminitis is more likely to indicate a serious acute liver injury (something recent). Mildly elevated levels may indicate mild inflammation due to a chronic liver disease or medications. Occasionally, it’s related to something outside of your liver.

What are the possible causes of transaminitis?

The most common causes of transaminitis are:

• Metabolic dysfunction-associated steatotic liver disease (MASLD). This is a common, chronic form of liver disease that many people don’t realize they have. It seems to be related to metabolic factors, like having high blood lipid levels, high blood sugar and overweight.
• Alcohol-induced hepatitis. Heavy alcohol use is another common cause of liver disease. Alcohol can cause both acute and chronic liver injury.

Other common causes include:

• Toxic hepatitis. Certain medications can have a toxic effect on your liver. Your healthcare provider may measure your transaminases to monitor the effects of these medications. A small, temporary rise may be okay, but significant transaminitis may mean you’re taking too much or that you shouldn’t take that medication.
• Viral hepatitis. Hepatitis viruses (A-E) can cause transaminitis. Hepatitis A is a temporary infection that goes away on its own. But hepatitis B and hepatitis C can both become chronic.
• Other viral infections. You might also have transaminitis with mononucleosis, (an Epstein-Barr virus infection,) herpes simplex virus (HSV) or cytomegalovirus (CMV) infections.

Less common causes of transaminitis include:

• Hemochromatosis.
• Wilson disease.
• Reye’s syndrome.
• Alpha-1 antitrypsin deficiency.
• Budd-Chiari syndrome.
• Autoimmune hepatitis.
• Congestive heart failure.
• Myocardial ischemia.
• Acute fatty liver of pregnancy (AFLP).
• HELLP syndrome.
• Celiac disease.
• Thyroid disease.
• Liver cancer.
• Sepsis.

What does it mean if one of my transaminases is more elevated than the other?

Usually, healthcare providers use the term “transaminitis” to indicate a rise in both transaminases together. This is typical of hepatitis, especially the acute kind. If your ALT is a little higher than your AST, this probably doesn’t mean anything different. ALT mostly relates to your liver. But AST is found in other tissues, too. If your AST is higher than your ALT, it could mean a few different things, including:

• Alcohol-related liver disease.
• Advanced liver disease (cirrhosis).
• Heart attack.
• Heatstroke.
• Muscular dystrophy.
• Myositis.
• Rhabdomyolysis.

How do healthcare providers treat transaminitis?

If your healthcare provider finds transaminitis on your blood test, they’ll want to know what’s causing it and how you’re doing overall. Sometimes, transaminitis appears before any other symptoms. But if you have other symptoms, your provider will assess them to determine your immediate needs. If you’re in acute liver failure, you might need critical care. Others might need medications for nausea or pain relief.

Your provider will follow up with tests to narrow down the cause of your transaminitis. They might check your levels again to confirm the result, then proceed to more specific blood tests to screen for viruses, genetic disorders or autoimmune diseases. If they suspect metabolic liver disease, they might check for features of metabolic syndrome. They might also check for fibrosis or scarring in your liver.

Is transaminitis curable?

Many causes of transaminitis are curable. Your prognosis will depend on the cause and how advanced your condition is. Most of the time, transaminitis is a warning sign that something is hurting your liver. If you and your healthcare provider can stop whatever it is, you can usually stop the damage and the transaminitis. Very severe damage might require critical care, or in some cases, a liver transplant.

A note from Cleveland Clinic

Transaminitis can mean different things in different settings. Sometimes, healthcare providers check for it after starting you on a new medication to see how it’s affecting your liver. Sometimes, they check for it because you have symptoms or a family history of a certain disease. And other times, they discover it unexpectedly on a routine blood test, in absence of any other signs or symptoms of disease.

Whether it’s expected or unexpected, transaminitis is just one piece of the puzzle in determining your overall condition. It might be just a passing condition, or one that’s been going on for a while. It might be dramatic or only slightly above normal. It’s often related to your liver, but it can be something else entirely. Your healthcare provider will launch an investigation to determine the next steps to take.