Potential etiopathogenesis of seventh day syndrome following living donor liver transplantation: ischemia of the graft?
BACKGROUND
Seventh-day syndrome (7DS) is an early serious complication following liver transplantation with a high mortality because of its unknown etiopathogenesis. This study aimed to analyze the potential etiopathogenesis of 7DS.


METHODS
A retrospective analysis of 98 consecutive living donor liver transplants performed from 2001 to 2007 at our center revealed that 5 patients had suffered from 7DS; their age, MELD score, portal vein inflow and other parameters were compared with those of the other recipients.


RESULTS
The 5 patients showed common features: (a) initial uneventful recovery, and a dramatic rise of serum liver enzyme levels 1 to 2 weeks later; (b) decreased inflow in the portal vein accompanied by augmentation of serum creatinine and urea nitrogen level; and (c) serial liver biopsy findings of apoptosis and ischemic necrosis of hepatocytes. Four of the 5 patients died. Age, waiting time to transplantation, MELD score, operation time, cold ischemic time, portal interceptive time and diameter of the portal vein were not significantly different between the 2 groups, but a difference was found in the flow rate of the portal vein (t=3.234, P<0.001).


CONCLUSIONS
The 5 patients suffered from a decreased portal vein inflow, ischemic liver necrosis, and renal failure. Hence, hypoperfusion of the liver graft was considered to be the etiopathogenesis of 7DS, for which, however sufficient evidence is lacking. More studies of 7DS are needed.
Division of Liver Transplantation, West China Hospital, Sichuan University, Chengdu 610041, China.
Xiang
X
Lan
Bo
B
Li
Xiao-Fei
XF
Wang
Yong-Gang
YG
Wei
Lu-Nan
LN
Yan
Ji-Chun
JC
Zhao
D000328:Adult; D001706:Biopsy; D005260:Female; D006084:Graft Rejection / Q000209:etiology*; D006801:Humans; D007511:Ischemia; D008099:Liver / Q000098:blood supply* / Q000201:enzymology / Q000473:pathology; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011169:Portal Vein / Q000503:physiopathology; D012039:Regional Blood Flow / Q000502:physiology; D012189:Retrospective Studies; D013577:Syndrome; D013997:Time Factors