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Aim: This the study aimed to describe the etiologic distribution, clinical characteristics, and outcomes of hypertransaminasemia in children.Material and Methods: This retrospective cohort study was conducted using electronic medical records of children aged 1 month–18 years who presented with persistent transaminase elevation between January 2023 and July 2024. Hypertransaminasemia was defined as alanine aminotransferase (ALT) >45 IU/L and/or aspartate aminotransferase (AST) >50 IU/L on at least two measurements with elevation persisting for at least 3 months. Patients with extrahepatic cholestasis or insufficient data were excluded. Demographic, clinical, laboratory, and imaging findings were collected, and etiologies were categorized. Subgroup analyses were performed based on cholestasis and ALT >10× the upper limit of normal (ULN).Results: Among 6886 first-time clinic visits, 214 children (3.1%) met the inclusion criteria. The cohort was predominantly male (55.6%) with a median age of 2.3 years, and parental consanguinity was notably high (79.9%). Infectious causes accounted for the majority of cases (65%), while metabolic/genetic disorders (9.3%), drug-induced liver injury (7%), metabolic dysfunction–associated steatotic liver disease (MASLD) (3.3%), and autoimmune disease (1.4%) were less frequent; 14% remained idiopathic. ALT >10×ULN was observed in 20.6% of patients, and cholestasis in 25.7%. Although these subgroups showed higher biochemical abnormalities, their etiologic patterns and normalization times were similar to the overall cohort. Follow-up data were available for 172 patients (80.4%); among them, transaminase levels normalized in 128 (74.4%), with a median time to normalization of 37.5 days (IQR 26.6–70).Conclusion: Hypertransaminasemia appears to be strongly influenced by regional factors, and establishing standardized pediatric reference ranges in Türkiye would substantially improve diagnostic accuracy.