Revising the Upper Limit of Normal for Levels of Serum Alanine Aminotransferase in a Middle Eastern Population with Normal Liver Histology

Al–Hamoudi, Waleed; Ali, Syed Qaseem; Hegab, Bassem; Elsiesy, Hussien; Hashim, Almoutaz; Al-Sofayan, M.; Khalaf, Hatem; Al-Bahili, Hamad; AlMasri, Nasser; Al-Sebayel, Mohammed; Broering, Dieter; Abdo, Ayman A.; Alqahtani, Saleh A.; Abaalkhail, Faisal

doi:10.1007/s10620-013-2659-0

Cited by 17 publications

(17 citation statements)

References 20 publications

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“…Pacifico et al 15 had summarized the reported ULNs of serum ALT levels in published studies 10, 84, 107-110, 113-118, 121. This review is incomplete due to omitting some additional references 47, 111, 112, 119, 120, 122, 123 and indirect comparisons. The etiology of ALT elevation can be attributed to viral hepatitis, excessive alcohol consumption, and metabolic disorders, including fatty liver disease 4, 35, 36, 83, in population-based studies.…”

Section: Several Concerns That Clinicians Should Raisementioning

confidence: 99%

Alanine Aminotransferase-Old Biomarker and New Concept: A Review

et al. 2014

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Measurement of serum alanine aminotransferase (ALT) is a common, readily available, and inexpensive laboratory assay in clinical practice. ALT activity is not only measured to detect liver disease, but also to monitor overall health. ALT activity is influenced by various factors, including viral hepatitis, alcohol consumption, and medication. Recently, the impact of metabolic abnormalities on ALT variation has raised concern due to the worldwide obesity epidemic. The normal ranges for ALT have been updated and validated considering the metabolic covariates in the various ethnic districts. The interaction between metabolic and demographic factors on ALT variation has also been discussed in previous studies. In addition, an extremely low ALT value might reflect the process of aging, and frailty in older adults has been raised as another clinically significant feature of this enzyme, to be followed with additional epidemiologic investigation. Timely updated, comprehensive, and systematic introduction of ALT activity is necessary to aid clinicians make better use of this enzyme.

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Section: Several Concerns That Clinicians Should Raisementioning

confidence: 99%

Alanine Aminotransferase-Old Biomarker and New Concept: A Review

et al. 2014

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“…There is limited histology‐based data on ALT cut‐offs. A study from Saudi Arabia including 110 prospective liver donors with normal histology found healthy ALT levels as 33 and 22 in males and females . Another histology‐based study from Korea including 1105 prospective liver donors found healthy ALT values as 35 and 26 IU/mL for males and females, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Two liver biopsy-based study including pro-spective liver donors from Saudi Arabia and Korea suggested lower ALT values. 10,11 In the present study, we evaluated ALT values in a large cohort of healthy Asian Indian liver donors based on histology.…”

Section: Introductionmentioning

confidence: 99%

Estimation of normal values of serum transaminases based on liver histology in healthy Asian Indians

Choudhary

Saraf

Saigal

et al. 2015

J of Gastro and Hepatol

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“…Moreover, the liver may have regenerative capacity and, if it is healthy in structure, it could tolerate significant loss of hepatocytes. Thus, it is difficult for a transplant surgeon to decide to use or discard an organ from a donor with elevated levels of serum transaminases (14-16). …”

Section: Discussionmentioning

confidence: 99%

Transplantation of Deceased Donor Livers With Elevated Levels of Serum Transaminases at Shiraz Transplant Center

Fakhar¹,

Nikeghbalian²,

Kazemi³

et al. 2016

Hepat Mon

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BackgroundThe current organ shortage has prompted the use of marginal organs. We conducted this retrospective study to present our experience with transplanting deceased donor livers with elevated levels of serum transaminases and to explain whether elevated levels of serum transaminases in donors affect allograft function and survival of the recipients.MethodsData of deceased donor livers and patients, who underwent liver transplantation from March 2013 to March 2015 at Shiraz center for organ transplantation, was reviewed. Liver donors with aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) level of more than 500 IU/l and their related recipients were considered as the case group (n = 24) and the others were considered as the control group (n = 834).ResultsIn the case group, the medians of levels of serum AST and ALT of donors were 834 ± 425 IU/L (range: 250 - 2285) and 507 ± 367 IU/L (range: 100 - 1600), respectively. Recipients were followed for a median of 13.6 ± 9 months (range: 7 - 28.4). Post-transplant complications were acute rejection (n = 5), infection (n = 3), portal vein thrombosis (n = 3), bile duct stricture (n = 1), and hepatic artery stenosis (n = 1). The one-year survival rate of the patients was 91.7%. Demographics, post-transplant complications and one-year survival rates were not significantly different between the two study groups.ConclusionsTransplanting deceased donor livers with markedly elevated liver enzymes may be an acceptable choice for expanding the donor pool.

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Revising the Upper Limit of Normal for Levels of Serum Alanine Aminotransferase in a Middle Eastern Population with Normal Liver Histology

Abstract: The ULN for ALT levels in Middle Eastern populations should be lowered, including separate values for males and females. Furthermore, metabolic parameters were shown to have a significant effect on ALT levels.

Cited by 17 publications

References 20 publications

Alanine Aminotransferase-Old Biomarker and New Concept: A Review

Alanine Aminotransferase-Old Biomarker and New Concept: A Review

Estimation of normal values of serum transaminases based on liver histology in healthy Asian Indians

Transplantation of Deceased Donor Livers With Elevated Levels of Serum Transaminases at Shiraz Transplant Center

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