{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T11:16:03Z","timestamp":1788434163332,"version":"build-2803163510"},"reference-count":29,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Modestly elevated serum alanine aminotransferase (ALT) levels are associated with increased morbidity and mortality in the general population; however, the perioperative significance of mildly elevated preoperative ALT levels in surgical patients remains unclear. Methods: This retrospective cohort study included adults undergoing non-hepatic, non-cardiac surgery at Samsung Medical Center. Patients with preoperative ALT measured within 3 months and &lt;2 times the upper limit of normal (ULN) were eligible. Preoperative ALT was categorized as lower (men 0\u201334 U\/L; women 0\u201322 U\/L) or higher (men 35\u201382 U\/L; women 23\u201366 U\/L). The primary outcome was marked postoperative ALT elevation, operationally defined as any postoperative ALT value &gt; 5 times the institutional ULN within 21 days after surgery. Propensity score matching was performed. Secondary outcomes included long-term ALT elevation, defined as an increase from the preoperative ALT value to &gt;2 times the ULN at the last available measurement within 1 year after surgery, and 1-year all-cause mortality. Results: Among 43,892 patients, 7740 (17.6%) were classified into the higher ALT group, and marked postoperative ALT elevation occurred in 733 patients (1.7%). After 1:1 propensity-score matching, 7660 patient pairs were analyzed, and marked postoperative ALT elevation occurred more frequently in the higher than in the lower ALT group (2.7% [204\/7660] vs. 1.6% [121\/7660]; OR 1.72, 95% CI 1.36\u20132.16; p &lt; 0.001). Higher preoperative ALT was also associated with long-term ALT elevation (OR 4.96, 95% CI 3.65\u20136.74; p &lt; 0.001) and increased 1-year mortality (5.4% vs. 4.4%; OR 1.25, 95% CI 1.08\u20131.45; p = 0.003). Conclusions: Higher preoperative ALT was associated with marked postoperative ALT elevation, long-term ALT elevation, and 1-year mortality, even within the conventional normal range. Preoperative ALT may therefore warrant consideration when evaluating postoperative risk.<\/jats:p>","DOI":"10.3390\/jcm15176824","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T10:10:33Z","timestamp":1788430233000},"page":"6824","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative Alanine Aminotransferase and Postoperative ALT Elevation: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Jisun","family":"Choi","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0343-6750","authenticated-orcid":false,"given":"Hyun Young","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Jeayoun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Seungwon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3760-1067","authenticated-orcid":false,"given":"MiHye","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3366","DOI":"10.1038\/s41467-025-58161-2","article-title":"Impact of perioperative organ injury on morbidity and mortality in 28 million surgical patients","volume":"16","author":"Kork","year":"2025","journal-title":"Nat. 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