title: Alpha-glutathione-S-transferase in acute rejection of liver transplant recipients.
abstract: BACKGROUND
  Alpha-glutathione-S-transferase (alphaGST) has been suggested as a sensitive marker of acute cellular rejection in liver transplantation. This study evaluated the usefulness of alphaGST as a marker of acute rejection in comparison with standard liver function tests.
  
  
  METHODS
  Daily measurements of liver function tests and alphaGST (enzyme immunometric assay, Biotrin) were prospectively recorded in 23 consecutive liver transplant recipients up to the time of discharge. Liver biopsies were performed as protocol biopsies or after clinical or biochemical deterioration in liver function, 38 of 56 showed acute rejection.
  
  
  RESULTS
  AlphaGST peaked on the second day (median, 125 microg/L; interquartile [IQ] range, 75-321 microg/L) and preceded the alanine transaminase (ALT) peak by 1 day. AlphaGST levels then steadily declined, reaching baseline by day 6, plateauing until day 8. After the initial peak, alphaGST still correlated well with the ALT (median correlation coefficient, 0.6; IQ range, 0.45-0.77) and with bilirubin concentration (median correlation coefficient, 0.47; IQ range, 0.14-0.6). There was no significant difference in alphaGST levels between those with rejection compared with other causes of hepatic dysfunction. The sensitivity and specificity of alphaGST for diagnosing acute rejection was 63.1% and 38.8%, respectively, compared with 97.4% and 16.7% for ALT. In 14 of the 16 patients treated for moderate or severe rejection, the improvement in the histological score of rejection was not associated with a consistent change in the alphaGST.
  
  
  CONCLUSIONS
  AlphaGST is not more useful than ALT in diagnosing rejection or determining response to treatment, but is a sensitive marker of liver injury.
authors.affiliation: Hepatobiliary Medicine and Liver Transplantation, Royal Free Hospital School of Medicine, London, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Nagral
authors.forename: P
authors.initials: P
authors.lastname: Butler
authors.forename: C A
authors.initials: CA
authors.lastname: Sabin
authors.forename: K
authors.initials: K
authors.lastname: Rolles
authors.forename: A K
authors.initials: AK
authors.lastname: Burroughs
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D005260:Female; D005982:Glutathione Transferase / Q000097:blood*; D006084:Graft Rejection / Q000175:diagnosis* / Q000201:enzymology / Q000473:pathology; D006801:Humans; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000276:immunology / Q000473:pathology / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results
chemical_list: D015415:Biomarkers; D005982:Glutathione Transferase; D000410:Alanine Transaminase; D001663:Bilirubin