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Do liver enzyme tests show liver damage?

One of the most confusing things for patients and doctors alike are “Liver Function Tests” (AST/ALT) which in fact measure no function of the liver at all. But these are chemicals that are found inside liver cells and they leak out into the blood at a very slow rate. So blood levels should be low. If liver cells are damaged, they leak out into the blood faster, and blood levels go up. So these are a rough measure of damage to the liver cells today. If your liver was badly damaged a month ago, but it’s better now, they may be normal. And it doesn’t predict, necessarily, liver damage in the future. It’s like taking your temperature. They’re commonly checked, but commonly given too much emphasis. There are people with cirrhosis and portal hypertension who have normal transaminases, normal ALT. And there are people who have elevated levels who’s liver otherwise is functioning perfectly normally, and doesn’t have cirrhosis. And it’s very common for Alphas to have a 2 or 3 or 4 time elevation of these and for the liver to be totally fine. Now if it’s 10 times, that’s bad and needs some significant attention. Commonly checked, commonly confused.

This was roughly transcribed from a talk Dr. Jeffery Teckman gave at the 2019 St. Louis Alpha-1 Education Day –