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 conce ntration (GST) has been shown to be a more sensitive and specific mark er 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 monito ring as a supplementary test to routine liver function tests during th e first 3 postoperative months after liver transplantation. Methods. M ortality and morbidity were compared in graft recipients who had their GST reported daily 60 the ward (reporting group) and graft recipients who did not. Results. The 3-month survival rate was significantly gre ater in the reporting group (P=0.033) and the risk of graft loss was h alved (relative hazard ratio=0.50; P=0.29). The reporting group also h ad significantly more patients who spent less than 3 weeks in the hosp ital throughout the follow-up period (P=0.036). In addition, the repor ting group experienced a lower frequency of biopsies per graft (P=0.03 8), less severe rejection (P=0.015), and a lower incidence of infectio n episodes per graft (P=0.03). GST increased by >50% above the upper l imit of the reference range at a median of 1 day before the equivalent change in alanine transaminase in association with allograft rejectio n 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 t he reporting group. Conclusions. We conclude that the monitoring of GS T may improve patient care, reducing both mortality and morbidity.