Clin Mol Hepatol > Volume 29(3); 2023 > Article
Oh and Sinn: Correspondence on Letter regarding “Is liver biopsy essential to identifying the immune tolerant phase of chronic hepatitis B?”
Dear Editor,
We would like to thank Professor Emiroglu [1] for showing interest in our paper. According to the guidelines established by the American Association for the Study of Liver Disease, the upper limit of normal for alanine aminotransferase (ALT) levels in healthy adult males is reported to range between 29–33 U/L [2]. However, to accommodate for differences in repeat testing for the same sample and to improve management decisions [3], it has been recommended to update the upper limit of normal for ALT in males to 35 U/L. Therefore, we agree that “<35 U/L” would be a more appropriate reference range for guidance. We will be mindful of any small errors that could cause confusion in decision-making.


Authors’ contribution
JHO drafted the manuscript. DHS reviewed and finalized the manuscript.
Conflicts of Interest
The authors have no conflicts to disclose.


alanine aminotransferase


1. Emiroglu HH. The upper limit of normal for ALT in males according to AASLD guideline. Clin Mol Hepatol 2023 May 8; doi: 10.3350/cmh.2023.0132.

2. Terrault NA, Lok ASF, McMahon BJ, Chang KM, Hwang JP, Jonas MM, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology 2018;67:1560-1599.
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3. Dutta A, Saha C, Johnson CS, Chalasani N. Variability in the upper limit of normal for serum alanine aminotransferase levels: a statewide study. Hepatology 2009;50:1957-1962.
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