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

Abstract

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.

Successful living donor liver retransplantation for graft failure within 7 days due to acute de novo donor‐specific anti‐human leukocyte antigen antibody‐mediated rejection

“…Its clinical features consist of a preceding high fever, a sharp rise in the liver enzymes, no surgical or vascular complications but an obvious decrease in portal venous flow rate, and massive hepatic necrosis in histology. The incidence of 7DS ranges from 0.5% to 5% . The consequences of 7DS are devastating, and the mortality rate is extremely high without retransplantation .…”

C4d immunopositivity is uncommon in ABO‐compatible liver allografts, but correlates partially with lymphocytotoxic antibody status

“…[1][2][3] However, the significance of humoral rejection has been less easy to recognize and evaluate in later and less dramatically acute episodes of liver allograft injury and in occasional distinctive cases with early massive haemorrhagic necrosis. 4,5 Preformed antidonor lymphocytotoxic antibodies are also associated with increased risk of early graft injury and failure in the first months, [6][7][8][9] and Demetris has documented in detail the clinicopathological features of humoral rejection in this patient group. 7 Typically, patients show high-titre IgG lymphocytotoxic antibodies that persist more than several days after transplantation, accompanied with low complement levels and thrombocytopenia.…”

Seventh-Day Syndrome: A Catastrophic Event After Liver Transplantation: Case Report

“…This completely contrasts with some cases described since the 1980s under different designations: septic hepatic gangrene, acute massive hepatic necrosis, massive hemorrhagic necrosis, nonthrombotic infarction, and, more recently, 7th-day syndrome (7DS) [2,3]. This syndrome, as described by Memon et al in 2001 [4], is an early serious complication following liver transplantation and is characterized by an unexpected sudden failure of a normally functioning liver graft w1 week after transplantation with no explainable causes. Its clinical features include a sharp increase to extremely high levels of liver enzymes, massive hepatocyte apoptosis, and liver or even multiple-organ failure, despite no evidence of acute rejection, liver thrombosis, infection, or surgical complications [2,3].…”