The role of tumor necrosis factor in allograft rejection. I. Evidence that elevated levels of tumor necrosis factor-alpha predict rejection following orthotopic liver transplantation

Transplantation. 1990 Aug;50(2):219-25. doi: 10.1097/00007890-199008000-00009.


Plasma levels of tumor necrosis factor-alpha were measured in 50 adult patients following orthotopic liver transplantation. The mean (+/- SEM) plasma concentration of TNF-alpha was significantly higher in patients experiencing a rejection episode (941 +/- 83 pg/ml) than in those with a stable clinical course (240 +/- 6 pg/ml; P = 0.0001). Peak levels of TNF-alpha were usually found at the time of clinically diagnosed rejection, although elevated levels were observed 1-2 days earlier. First-week peak TNF-alpha levels were significantly higher in patients who suffered graft loss (2146 +/- 788 pg/ml) than in those who were discharged from the hospital without clinical evidence of rejection (581 +/- 93 pg/ml; P = 0.004). TNF-alpha levels were not correlated with white blood cell count (r2 = 0.004), cyclosporine levels (0.01), serum creatinine (0.002), serum bilirubin (0.05), serum SGOT (0.03), or SGPT (0.05). TNF-alpha levels were not elevated in four cases of viral hepatitis occurring after transplantation. We conclude that circulating levels of TNF-alpha are elevated during liver allograft rejection and may precede clinical manifestations. First-week TNF-alpha levels are also useful predictors of long-term graft outcome. Further investigation is required to determine whether this monokine is important in the actual pathogenesis of allograft rejection.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Alanine Transaminase / blood
  • Analysis of Variance
  • Antibodies, Monoclonal / therapeutic use
  • Aspartate Aminotransferases / blood
  • Bilirubin / blood
  • Cyclosporins / therapeutic use
  • Enzyme-Linked Immunosorbent Assay
  • Graft Rejection*
  • Humans
  • Leukocyte Count
  • Liver Transplantation / immunology*
  • Middle Aged
  • Prospective Studies
  • Time Factors
  • Tumor Necrosis Factor-alpha / metabolism*


  • Antibodies, Monoclonal
  • Cyclosporins
  • Tumor Necrosis Factor-alpha
  • Aspartate Aminotransferases
  • Alanine Transaminase
  • Bilirubin