Randomized trial to evaluate the clinical benefits of serum alpha-glutathione S-transferase concentration monitoring after liver transplantation.
BACKGROUND
An increase in serum alpha-glutathione S-transferase concentration (GST) has been shown to be a more sensitive and specific marker of hepatocellular damage than equivalent increases in transaminase activities. A randomized clinical trial of 60 liver transplants in 49 patients was carried out to assess the clinical benefits of GST monitoring as a supplementary test to routine liver function tests during the first 3 postoperative months after liver transplantation.


METHODS
Mortality and morbidity were compared in graft recipients who had their GST reported daily to the ward (reporting group) and graft recipients who did not.


RESULTS
The 3-month survival rate was significantly greater in the reporting group (P=0.033) and the risk of graft loss was halved (relative hazard ratio=0.50; P=0.29). The reporting group also had significantly more patients who spent less than 3 weeks in the hospital throughout the follow-up period (P=0.036). In addition, the reporting group experienced a lower frequency of biopsies per graft (P=0.038), less severe rejection (P=0.015), and a lower incidence of infection episodes per graft (P=0.03). GST increased by >50% above the upper limit of the reference range at a median of 1 day before the equivalent change in alanine transaminase in association with allograft rejection in the combined groups (95% confidence interval=1 to 2 days) but was lower on the day of diagnosis of rejection in the reporting group (P=0.02). This is compatible with the earlier diagnosis of rejection in the reporting group.


CONCLUSIONS
We conclude that the monitoring of GST may improve patient care, reducing both mortality and morbidity.
Hughes
V F
VF
Department of Clinical Biochemistry, Addenbrooke's Hospital, Cambridge, England.
Trull
A K
AK
Gimson
A
A
Friend
P J
PJ
Jamieson
N
N
Duncan
A
A
Wight
D G
DG
Prevost
A T
AT
Alexander
G J
GJ
D000328:Adult; D005069:Evaluation Studies as Topic; D005260:Female; D005982:Glutathione Transferase / Q000097:blood*; D006801:Humans; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic
D005982:Glutathione Transferase