SERUM ALPHA-GLUTATHIONE S-TRANSFERASE - A SENSITIVE MARKER OF HEPATOCELLULAR DAMAGE ASSOCIATED WITH ACUTE LIVER ALLOGRAFT-REJECTION

The wide hepatic distribution, high cytosolic concentration, and short in vivo plasma half-life of serum alpha-glutathione s-transferase are properties which may make monitoring this enzyme more clinically usef ul than conventional biochemical liver function tests as a marker of h epatocellular damage associated with acute liver allograft rejection. In a prospective longitudinal study of 58 liver transplants in 45 pati ents, serum alpha-glutathione s-transferase concentrations rose signif icantly more consistently and more rapidly than conventional liver fun ction tests in association with acute rejection. However, a rise in a glutathione s-transferase was less specific for rejection than convent ional liver function tests although none of the tests had a positive p redictive value for rejection of greater than 32%. Compatible with the particularly short in vivo plasma half-life of this enzyme, alpha-glu tathione s-transferase concentrations fell to or toward normal more ra pidly than conventional Liver function test measurements following unc omplicated transplantation as well as during high-dose steroid treatme nt of rejection. This may be valuable, both in improving the resolutio n of biochemical changes associated with early rejection episodes and in determining when treatment of rejection has been successful. Furthe r studies are warranted, however, to assess whether the fall in GST du ring rejection treatment does genuinely reflect the histological resol ution of rejection.