Seventh Day Syndrome – acute hepatocyte apoptosis associated with a unique syndrome of graft loss following liver transplantation^Note

: The aim of this study is to describe a unique 7th day syndrome (7DS), quite different from other causes of post‐transplantation allograft dysfunction in a group of orthotopic liver transplant (OLT) patients who needed retransplantation. A retrospective analysis of 594 consecutive OLT over an 8‐year period revealed that 10 patients developed allograft dysfunction approximately 7 days following an initially normal graft function. The features included: (a) severe liver failure; (b) sudden peak of extremely high liver enzymes at approximately day 7; (c) serial liver biopsy findings of central lobular hemorrhage with minimal inflammatory cell infiltrate and (d) an explant with no evidence of vascular thrombosis. The biochemical and morphometric pathological data of these patients were compared with data of patitents who had early acute rejection (AR), hepatic artery thrombosis (HAT), primary non‐function (PNF), severe sepsis and no dysfunction. Lastly, serial liver core biopsies and explants were tested for evidence of apoptosis, which revealed a significantly higher number of apoptotic hepatocytes in 7DS compared to all control groups. Seventh Day Syndrome is a distinct entity associated with early graft dysfunction characterized by a marked apoptosis of hepatocytes. Fas receptor activation or other pathways of program cell death may be implicated in occurrence of 7DS.

Duke Scholars

Author John Wiley Williams Jr. Medicine, General Internal Medicine