Is It Necessary to Order Aspartate Aminotransferase with Alanine Aminotransferase in Clinical Practice?

We read with great interest the articles by Dufour et al., “Diagnosis and monitoring of hepatic injury. I. Performance characteristics of laboratory tests” (1) and “Diagnosis and monitoring of hepatic injury. II. Recommendations for use of laboratory tests in screening, diagnosis, and monitoring” (2). These articles address an important but somewhat controversial subject. Broughton and Worthington (3) reported that an order for liver function tests produced 17 different test combinations in 19 different laboratories. This shows that there is no real consensus on the use of liver function tests. We thus want to add some remarks to the articles regarding aspartate aminotransferase (AST) and alanine aminotransferase (ALT). In our opinion, the use of AST can be reduced, and we think that it is not necessary to order AST with ALT in routine practice. The information presented by Dufour et al. (1) on factors affecting the transaminases is important, but drug effects must be added. Several hundred drugs have been reported to affect AST or ALT (4).