sTNF-RII:: is it useful for the early diagnosis of rejection and for prognosis after renal transplantation?

Changes in soluble tumour necrosis factor receptor II (sTNF-RII) correlate with transplant rejection, and it increases in the course of sepsis. These changes might help to identify rejection early, and thus lead to more effective treatment. Serum and urine sTNF-RII levels were measured in 70 patients during the first 3 weeks after kidney transplantation and correlated with clinical and laboratory findings. Retrospectively, three groups were identified: I. stable transplant function (n = 23), II. at least one rejection episode (n = 3 8) and III. other complications (infection or reperfusion injury) (n = 9). The pre-operative maximum for serum sTNF-RII was 22.4 +/- 10.7 ng/ml. In group I it decreased to 9.5 +/- 6.7 ng/ml on day 6 after transplantation (P < 0.01), while in group 11 sTNF-RII serum levels were significantly higher on day 6 (24.9 +/- 15.0 ng/ml, P < 0.01). High levels of sTNF-RII in serum (> 40 ng/ml for at least 2 days) predicted a higher risk of an unfavourable outcome. High serum levels of sTNF-RII are not specific but seem to be a prognostic indicator of a complicated course; sTNF-RII in urine has no diagnostic value.