Significance of Changes of Tumor Necrosis Factor-alpha in Blood and Urine as a Early Diagnostic Tool of Acute Rejection in Renal Allograft

Kim, Gyu Rag; Huh, Young Soo; Suh, Bo Yang; Kwun, Koing Bo

Abstract

This is a report of 51 cases in renal allograft, which were treated at the Yeungnam University Hospital from February 1994 to July 1996 and compared the significance of changes of TNF-alpha in blood and urine as a diagnostic tool of acute rejection in renal allograft. The aim of this study was to investigate the value of plasma and urinary TNF-alpha in patients with renal allografts. Renal allografts divided them into four groups (control, acute rejection, acute tubular necrosis and systemic infection) that obtained plasma and urinary TNF-alpha. The sampling day of blood and urine in each group were as follows: in control group at the day of transplantation and postoperative 1, 5, 7 days respectively, in acute rejection group at before the day of initiation of therapy and the 1, 3 days after therapy, in acute tubular necrosis group at the day of low urine output and the 4 subsequent days, and in systemic infection group at the day of diagnosis and the 3 subsequent days. The results were as follows: Plasma TNF-alpha levels were significantly elevated in 68.4% (p<0.01) of acute rejection group and 100.0% (p<0.05) of systemic infection group but did not increase in acute tubular necrosis group (20.0%, p>0.05). In contrast, urinary TNF-alpha were detected in acute rejection group (42.1%, p<0.01) and acute tubular necrosis group (20.0%, p<0.05). Control and systemic infection groups were not detectable in urinary TNF-alpha. The results suggested that plasma and urinary TNF-alpha may be used as the complementary diagnostic tool of acute rejection in renal allograft patients.