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In my experience, elevated ALT and/or AST are not necessarily indicative of primary liver dysfunction. Even a simple dental infection could cause elevated ALT or AST. My boy, Boo, who is now over 17, has had fluctuating ALT and AST most of his life. At times, ALT has exceeded 450 IU/L, despite the fact that he appeared to be overtly healthy. I did work-up about 13 years ago, which did not confirm primary liver dysfunction, or the need for surgical intervention. In fact, I have never really been able to get a clear answer about the reason for the periodic elevation in ALT and AST levels. Fortunately, his most recent blood work in 3/2020 showed only a slight elevation of the ALT level and a normal AST level. Try not to worry. Sometimes, just having the teeth cleaned will lower the ALT dramatically. Also, there is a supplement called Denamarin, which helps to lower ALT. Wishing you and Bailey the best.