storage before transplantation correlates clinically with inThe injury resulting from cold ischemia and warm recreased primary graft nonfunction, graft rejection, and rate perfusion during liver transplantation is a major clinical of re-transplantation. 4,5 problem that limits graft success. Kupffer cell activation Reperfusion injury is difficult to study clinically, but has plays a pivotal role in reperfusion injury, and Kupffer been investigated in animal models, including orthotopic cell products, including free radicals and tumor necrosis liver transplantation in rats. These studies have shown that factor a (TNF-a), are implicated as damaging agents.hepatic reperfusion following ischemia induces Kupffer cell However, the second messengers and signaling pathactivation, superoxide formation, and elevated plasma levels ways that are activated by the stress of hepatic ischemia/ of tumor necrosis factor a (TNF-a). 6,7 Pretreatment with reperfusion remain unknown. The purpose of this study methyl palmitate inhibits Kupffer cell activation and imis to assess the activation of the three known vertebrate mitogen activated protein kinase (MAPKs) and the acti-proves transplant survival threefold, thereby supporting a vating protein 1 (AP-1) transcription factor in response role for Kupffer cells in reperfusion injury. 8 In addition, treatto ischemia and reperfusion in the transplanted rat ment with agents that suppress TNF-a release from activated liver. There was a potent, sustained induction of c-jun Kupffer cells decrease transplant failure.9 Nisoldipine, a Ca 2/ N-terminal kinase (JNK), but not of the related MAPKs channel blocker, reduces plasma levels of TNF-a and inextracellular signal-regulated kinases (ERK) or p38, creases transplant survival time. 10,11 Similarly, pentoxifylupon reperfusion after transplantation. TNF-a messen-line, a methylxanthine which suppresses TNF-a messenger ger RNA (mRNA) levels and transcription factors AP-1 RNA (mRNA) accumulation in response to lipopolysacchaand nuclear factor-kB (NF-kB) were induced in the liver ride, has a protective effect on liver grafts.12 Taken together, after 60 minutes of reperfusion. Finally, there was an these data suggest an important role for TNF-a in mediating elevation of ceramide, but not diacylglycerol or sphingo-reperfusion injury. sine, in the transplanted liver. Ceramide is a second mes-TNF-a is a pleiotropic cytokine that induces cellular effects senger generated by TNF-a treatment and is an activator ranging from proliferation to apoptosis. TNF-a is a potent of JNK. Because JNK activation preceded the elevations activator of activating protein 1 (AP-1) and NF-kB transcripin ceramide and TNF-a mRNA, these results suggest that tion factors and of the c-jun N-terminal kinase (JNK, also increased hepatic TNF-a and ceramide may perpetuate known as stress-activated protein kinase, SAPK).13-15 JNK is JNK induction, but that they are not the initiating sig-a member of the vertebrate mitogen activated protein kinase nals of JNK activation during reperfus...