Six patients met the criteria of “nR Hy’s law” ([(ALT/ULN) ÷ (ALP/ULN)] > 5 and total bilirubin (TBL) > 2.5 mg/dL) [33], hence considered at a higher risk of progressing to acute liver failure, with one of these patients progressing to acute liver failure and receiving a liver transplant. The gene discussed is GPT; the disease is acute liver failure.