Seventh Day Syndrome - acute hepatocyte apoptosis associated with a uniquesyndrome of graft loss following liver transplantation

Aim: The aim of this study is to describe a unique 7th day syndrome (7DS), quite different from other causes of post-transplantation allograft dysfunc tion in a group of orthotopic liver transplant (OLT) patients who needed re transplantation. Methods: A retrospective analysis of 594 consecutive OLT o ver an 8-year period revealed that 10 patients developed allograft dysfunct ion approximately 7 days folio-wing an initially normal graft function. Res ults: The features included: (a) severe liver failure; (b) sudden peak of e xtremely high liver enzymes at approximately day 7; (c) serial liver biopsy findings of central lobular hemorrhage with minimal inflammatory cell infi ltrate and (d) an explant with no evidence of vascular thrombosis. The bioc hemical and morphometric pathological data of these patients were compared with data of patients who had early acute rejection (AR), hepatic artery th rombosis (HAT), primary nonfunction (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 hep atocytes in 7DS compared to all control groups. Conclusions: Seventh Day Sy ndrome is a distinct entity associated with early graft dysfunction charact erized by a marked apoptosis of hepatocytes. Fas receptor activation or oth er pathways of program cell death may be implicated in occurrence of 7DS.