GLUTATHIONE-S-TRANSFERASE AS PREDICTOR OF FUNCTIONAL OUTCOME IN TRANSPLANTATION OF MACHINE-PRESERVED NON-HEART-BEATING DONOR KIDNEYS

Non-heart-beating (NHB) donors are a valuable source of kidneys for tr ansplantation. The organs, however, sustain substantial warm ischemic damage that may jeopardize the transplantability and result in nonfunc tion of the grafts, Quantification of warm ischemic time (WIT) and pre diction of transplant outcome are essential for the use of NHB donor o rgans. During machine preservation (MP) the viability of NHB donor kid neys was evaluated through calculating intrarenal vascular resistance and determining lactate dehydrogenase and ru-glutathione S-transferase (alpha GST) in the perfusate. Thirty-seven functioning (F) and nine n onfunctioning kidneys (NF) were compared. WIT was longer in NF; serum creatinine, donor age, and preservation time were not different, WIT c orrelated well with alpha GST after 4 and 8 hr of MP (r=0.353, P=0.009 , and r=0.346, P=0.011, respectively), When compared with F, intrarena l vascular resistance was increased in NF after 4 and 8 hr of perfusio n (P<0.05); at all time points, alpha GST levels were elevated in NF ( P<0.05). Lactate dehydrogenase activity was not different between the groups, but could identify immediate functioning grafts within the F g roup. In conclusion, (alpha GST levels correlated strongly with WIT an d were also able to distinguish NF from F grafts. alpha GST can adequa tely predict the functional outcome of NHB donor grafts before transpl antation; levels of alpha GST can be used to define reliable safety ma rgins for viability, Therefore, MP is useful in evaluating the viabili ty of NHB donor kidneys, and the parameters discussed will help to sel ect nonviable grafts from this valuable pool of kidneys for transplant ation.