6.416667
#149
ELEVATED SERUM TUMOR NECROSIS FACTOR-ALPHA IN RENAL ALLOGRAFT REJECTION.
Lorita Rebellato Ph.D. ¹, Karlene Hewan-Lowe M.D. ¹, Kim Briley B.S. ¹, Jessica Harrel B.S. ¹ and James de Vente M.D.,Ph.D. ¹. ¹ Pathology & Laboratory Medicine, Physiology, Obstetrics & Gynecology, The Brody School of Medicine at East Carolina University, Greenville, NC, USA .

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Tumor necrosis factor-alpha, a mediator of cellular immunity, has been demonstrated in the rejecting kidney. Thus, elevated levels of serum TNF-alpha could be used as an indicator of renal allograft rejection.
Sera from renal transplant recipients with allograft dysfunction and stable allografts were tested for Human TNF-alpha (Quantikine HS kit; RD Systems, Inc). Monitoring of antibodies (Ab) to HLA Class I and II were performed using the Lambda Antigen Tray (One Lambda, Inc). Biopsies from patients with allograft dysfunction were evaluated for rejection and for C4d (Quidel, CA) deposition in peritubular capillaries. Statistical analysis consisted of Wilcoxon Scores (Rank Sums; SAS). The rejection group consisted of 50% males, average age 46 years (range 14-66). The control group consisted of 53.3% males, average age 50 years (range 29-70). Both groups received similar induction and maintenance immunosuppression.
Serum TNF-alpha levels were elevated in patients experiencing a rejection episode (p<0.01). These patients had cellular rejection, humoral rejection, anti-HLA-Ab and C4d staining (See Table). The control group had no circulating anti-HLA-Ab and normal renal function.
Serum levels of TNF-alpha in combination with other parameters, such as anti-HLA-Ab, can be used to assess rejection episodes in renal allograft recipients.

	Donor Type	ABDR Mismatches (Mean)	Type of Rejection	TNF-Alpha (pg/ml) (Mean +/- SEM)	C4d	Anti-HLA-Ab
Rejection Group (n=12)	Deceased 3	2.3	Banff IA 5	11.1 +/- 5.0	4	9
	LRD 8		Banff IB 2
	LURD 1		Banff IIA 3
			Banff IA/ IIA 2
Control Group (n=15)	Deceased 3	3.1	N/A	5.6 +/- 2.3	N/A	0
	LRD 8
	LURD 4