title: Glutathione S-transferase iso-enzymes in perfusate from pumped kidneys are associated with delayed graft function.
abstract: Accurate and reliable assessment tools are needed in transplantation. The objective of this prospective, multi-center study was to determine the associations of the alpha and pi iso-enzymes of glutathione S-transferase (GST), measured from perfusate solution at the start and end (base and post) of kidney allograft machine perfusion, with subsequent delayed graft function (DGF). We also compared GST iso-enzyme perfusate levels from discarded versus transplanted kidneys. A total of 428 kidneys were linked to outcomes as recorded by the United Network of Organ Sharing. DGF, defined as any dialysis in the first week of transplant, occurred in 141 recipients (32%). Alpha- and pi-GST levels significantly increased during machine perfusion. The adjusted relative risks (95% confidence interval) of DGF with each log-unit increase in base and post pi-GST were 1.14 (1.0-1.3) and 1.36 (1.1-1.8), respectively. Alpha-GST was not independently associated with DGF. There were no significant differences in GST values between discarded and transplanted kidneys, though renal resistance was significantly higher in discarded kidneys. We found pi-GST at the end of machine perfusion to be independently associated with DGF. Further studies should elucidate the utility of GST for identifying injured kidneys with regard to organ allocation, discard and recipient management decisions.
authors.affiliation: Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, CT; Section of Nephrology, Yale University School of Medicine, New Haven, CT.
authors.forename: I E
authors.initials: IE
authors.lastname: Hall
authors.forename: R S
authors.initials: RS
authors.lastname: Bhangoo
authors.forename: P P
authors.initials: PP
authors.lastname: Reese
authors.forename: M D
authors.initials: MD
authors.lastname: Doshi
authors.forename: F L
authors.initials: FL
authors.lastname: Weng
authors.forename: K
authors.initials: K
authors.lastname: Hong
authors.forename: H
authors.initials: H
authors.lastname: Lin
authors.forename: G
authors.initials: G
authors.lastname: Han
authors.forename: R D
authors.initials: RD
authors.lastname: Hasz
authors.forename: M J
authors.initials: MJ
authors.lastname: Goldstein
authors.forename: B
authors.initials: B
authors.lastname: Schröppel
authors.forename: C R
authors.initials: CR
authors.lastname: Parikh
mesh_terms: D015415:Biomarkers / Q000378:metabolism*; D051799:Delayed Graft Function / Q000175:diagnosis* / Q000201:enzymology / Q000209:etiology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D051549:Glutathione S-Transferase pi / Q000378:metabolism*; D005982:Glutathione Transferase / Q000378:metabolism*; D006801:Humans; D007527:Isoenzymes / Q000378:metabolism*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000601:surgery; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D011183:Postoperative Complications / Q000175:diagnosis* / Q000201:enzymology / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D007527:Isoenzymes; D051549:Glutathione S-Transferase pi; D005982:Glutathione Transferase; C119995:glutathione S-transferase alpha
keywords: Biomarker; ischemia; kidney injury; perfusion pumping