Prolonged abnormal isolated aminotransferase levels in healthy children is a benign condition

Hypertransaminasaemia is a common incidental finding in children. It has been demonstrated that even prolonged elevation usually resolves spontaneously without clear aetiology. The aim of this study was to evaluate whether a longer follow-up period, on a larger group, supports the previous findings.

We retrospectively reviewed medical charts of children diagnosed with prolonged idiopathic hypertransaminasaemia, which spontaneously resolved over the follow-up period.

Of the 468 patients screened for elevated transaminases levels, 87 patients younger than 5 years of age were included in the study. An aetiology was found in half of the patients, and the most common aetiologies were fatty liver and cytomegalovirus (CMV) infection. Aminotransferase abnormality persisted for a median of 10 months, and alanine aminotransferase (ALT) levels ranged from 1.5 to 15.9-fold of the upper limit of normal (ULN). After normalisation of transaminase levels, the values remained normal for a documented mean period of 6.4 ± 3.0 years.

Although idiopathic asymptomatic aminotransferase elevation in healthy children resolves spontaneously in most children, the abnormality may be prolonged. Comprehensive workup finds aetiology only in half of the patients, and the most common aetiologies are fatty liver and CMV hepatitis, which can be diagnosed by non-invasive methods.