Activity of glutathione S-transferases in the urine of kidney transplant recipients during the first week after transplantation.
Glutathione S-Tranferases (GST) are the enzymes which are strictly specific for epithelial cells of the proximal and distal tubules in the kidney. These enzymes are detected in the urine when some tubular damage process is found. In healthy people urine GST is hardly detected. The goal of this study was to evaluate the release of two isoenzymes -- alpha and pi GST in the urine of kidney graft recipients during the first week after kidney transplantation, aiming to differentiate the cause of the delayed function (DF) of transplanted kidney.


METHODS
50 cadaveric kidneys were procured using standard technique with "in situ" cooling using UW solution. All kidneys were machine perfused. After preservation kidneys were transplanted to 50 ERSD patients. Standard triple drug immunosuppression was applied (steroids, CsA, Cell-Cept or Aza.). Graft function and the release of alpha and pi GST in the urine were measured 1, 3 and 7 days after transplantation.


RESULTS
immediate function (IF) was found in 72% (36pts), DF in 28% (14pts). 5 of DF patients had ATN, 4 had acute rejection (REJ) and the remaining 5 had ATN and acute rejection (see table below).


CONCLUSIONS
High alpha and pi GST concentrations were found in pts with DF graft function during the first 7 days after Tx. Elevated pi GST and low alpha GST in the urine indicates acute rejection. High alpha and pi GST in pts with DF should raise suspicion of graft rejection.
Polak
W P
WP
Department of General and Transplantation Surgery, Medical University of Warsaw, Poland.
Kosieradzki
M
M
Kwiatkowski
A
A
Danielewicz
R
R
Lisik
W
W
Michalak
G
G
Paczek
L
L
Lao
M
M
Wałaszewski
J
J
Rowiński
W A
WA
D016572:Cyclosporine / Q000009:adverse effects; D051549:Glutathione S-Transferase pi; D005982:Glutathione Transferase / Q000652:urine*; D006084:Graft Rejection / Q000175:diagnosis / Q000201:enzymology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007527:Isoenzymes / Q000652:urine; D007676:Kidney Failure, Chronic / Q000201:enzymology / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects / Q000502:physiology*; D007683:Kidney Tubular Necrosis, Acute / Q000175:diagnosis / Q000201:enzymology / Q000209:etiology; D013997:Time Factors
D007166:Immunosuppressive Agents; D007527:Isoenzymes; D016572:Cyclosporine; C496556:GSTP1 protein, human; D051549:Glutathione S-Transferase pi; D005982:Glutathione Transferase; C119995:glutathione S-transferase alpha