Background: With a universal shortage of donor organs, screening and
selection of marginal kidneys from non-heart-beating donors (NHBDs) provides a
valuable source for transplantation. Pre-transplant viability assessment is based on
a combination of flow characteristics and assessment of ischaemic tissue injury
during NHBD kidney machine perfusion by measurement of total glutathione
S-transferase (GST) activity. Successful viability screening has facilitated 69 renal
transplants from 60 NHBDs within our transplant centre since 1998, with a first-year
graft survival of 90·5%.
Methods: We have investigated alanine aminopeptidase (Ala-AP) and fatty
acid binding protein (FABP) as alternative biochemical markers to GST for
pre-transplantation viability assessment. They were measured, together with GST, in
tissue perfusate samples from machine-perfused kidneys from controlled and
uncontrolled NHBDs.
Results: During machine perfusion, a parallel response was seen for each
of the three markers in the perfusates of controlled and uncontrolled NHBD kidneys
over the 4-h perfusion. A highly significant correlation was obtained between GST and
Ala-AP activities (P<0·0001) and between GST activity and FABP concentration
(P<0·0001) in corresponding samples.
Conclusion: In this study, GST, Ala-AP and FABP represent equivalent
biochemical markers in terms of their ability to quantitate renal tissue injury in
human NHBD kidneys. However, there may be some advantage in using all three analytes
to provide complementary information on kidney allograft viability.
