HEPATOCELLULAR INTEGRITY IN LIVER-DONORS AND RECIPIENTS INDICATED BY GLUTATHIONE TRANSFERASE-ALPHA

Glutathione transferase Alpha (GSTA) is a sensitive indicator of hepat ocellular integrity. Its reference range is low (0.7-14 mu g/L) and it s half-life is short (1 hr) in serum. We evaluated the changes in GSTA concentration in 18 recipients during and after liver transplantation . The respective liver donors were also included in 13 cases. The base line GSTA concentrations were normal or slightly elevated in all donor s, 1.2-79 mu gL (median 5.1 mu g/L), and recipients, 1.1-34 mu g/L (me dian 6.4 mu g/L). Surgical dissection of donor liver caused a moderate or even large increase in GSTA concentration, peak 80-6500 mu g/L (me dian 800 mu g/L). In the recipients the peak of GSTA concentrations va ried from 1400 to 47000 mu g/L (median 5000 mu g/L), and it was always observed within 45 min after reperfusion of the graft. The highest GS TA values were observed after long cold ischemia and in patients trans planted for acute liver failure. However, they were not associated wit h early graft dysfunction. There was a correlation between the AUC of GSTA and cold ischemia time in the recipients with chronic nonalcoholi c liver failure (r=0.94). There was no correlation between GSTA values in the donors and recipients (r=0.14). The apparent half-life of GSTA in serum was 56 min (median). Perioperative GSTA concentrations in th e donors had no obvious predictive value. In the recipients an excepti onally long apparent half-life of GSTA immediately after transplantati on or a large second increase in GSTA were predictors of postoperative complications.