Newly Defined Clinical Features and Treatment Experience of Seventh Day Syndrome Following Living Donor Liver Transplantation

AimThe aim of this study was to describe a unique Seventh-Day Syndrome (7DS) in our liver transplantation center.MethodsWe performed a retrospective analysis of 244 cases of adult living donor liver transplantations (LDLT) performed in our liver transplantation center from January 1995 to January 2009.ResultsSince 2005, we identified 8 cases of 7DS. Previously reported features for 7DS include a rapid deterioration of liver function followed by renal failure and a sudden peak in liver enzyme levels around day 7. In addition, the following attributes have been observed in our patients: (1) all recipients were males while the donors included both genders; (2) most patients showed increased levels of irritability; (3) color Doppler revealed reduced blood flow or bidirectional blood flow in the portal vein; (4) coagulation necrosis was observed with disruption of lobular architecture and increased expression of death receptor Fas in all examined patients; (5) after onset, a steroid pulse with or without OKT3 therapy showed minimal effect; (6) a abrupt increase in liver enzymes was noted 1–2 days after intravenous (IV) methylprednisolone was switched to oral immunosuppressants; and (7) extension of IV methylprednisolone treatment delayed the occurrence from 8 to 11 days postoperatively.Conclusions7DS is a distinct entity associated with early graft dysfunction, which is associated with a high rate of mortality and need for retransplantation. Coagulation necrosis and Fas receptor activation may be implicated in the occurrence of 7DS. Our study supported the hypothesis that 7DS may be associated with an undefined immune response. Our experience extending IV methylprednisolone treatment seeking to delay occurrence and reduce mortality provided a possible therapeutic approach for 7DS.