Rejection and ischemia are serious complications after liver transplantation. Early detection is mandatory, but specific markers are largely missing, particularly for rejection. The objective of this study was to explore the ability of microdialysis catheters inserted in liver grafts to detect and discriminate rejection and ischemia through postoperative measurements of inflammatory mediators. Microdialysis catheters with a 100-kDa pore size were inserted into 73 transplants after reperfusion. After the study's completion, complement activation product 5a (C5a), C-X-C motif chemokine 8 (CXCL8), CXCL10, interleukin-1 (IL-1) receptor antagonist, IL-6, IL-10, and macrophage inflammatory protein 1b were analyzed en bloc in all grafts with biopsy-confirmed rejection (n ¼ 12), in grafts with vascular occlusion/ischemia (n ¼ 4), and in reference grafts with a normal postoperative course of circulating transaminase and bilirubin levels (n ¼ 17). The inflammatory mediators were elevated immediately after graft reperfusion and decreased toward low, stable values during the first 24 hours in nonischemic grafts. In grafts suffering from rejection, CXCL10 increased significantly (P ¼ 0.008 versus the reference group and P ¼ 0.002 versus the ischemia group) 2 to 5 days before increases in circulating alanine aminotransferase and bilirubin levels. The area under the receiver operating characteristic curve was 0.81. Grafts with ischemia displayed increased levels of C5a (P ¼ 0.002 versus the reference group and P ¼ 0.008 versus the rejection group). The area under the curve was 0.99. IL-6 and CXCL8 increased with both ischemia and rejection. In conclusion, CXCL10 and C5a were found to be selective markers for rejection and ischemia, respectively. Liver Transpl 18:1421-1429, 2012. V C 2012 AASLD.Received March 30, 2012; accepted June 13, 2012.Most rejections of liver transplants are cellular rather than antibody-mediated, and T lymphocytes are central players.1 Acute cellular rejection (ACR) typically occurs within the first 6 weeks after transplantation and is a relatively frequent complication with an incidence in the range of 30% to 60%.2 The detection and subsequent treatment of ACR are important because the condition may have a negative impact on outcomes, particularly for patients undergoing transplantation for hepatitis C cirrhosis and primary sclerosing cholangitis. [2][3][4][5][6][7] ACR is suspected when the activity of circulating transaminases and/or concentrations of Abbreviations: ACR, acute cellular rejection; ALT, alanine transaminase; AST, aspartate transaminase; AUC, area under the curve; C5a, complement activation product 5a; CI, confidence interval; CXCL, C-X-C motif chemokine; IL, interleukin; IL-1ra, interleukin-1 receptor antagonist; MIP, macrophage inflammatory protein; OLT, orthotopic liver transplantation; s-ALT, serum alanine aminotransferase.