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Successful management to prevent early graft loss due to Seventh‐day Syndrome after liver retransplantation: A case report and literature review
Author(s) -
Matsuura Toshiharu,
Kohashi Kenichi,
Kawano Yuki,
Takahashi Yoshiaki,
Yoshimaru Koichiro,
Yoshizumi Tomoharu,
Oda Yoshinao,
Mori Masaki,
Taguchi Tomoaki
Publication year - 2021
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.13907
Subject(s) - medicine , liver transplantation , desensitization (medicine) , surgery , transplantation , pathological , gastroenterology , receptor
Graft loss characterized by sudden deterioration after initial favorable recovery of the allograft function within the first week after liver transplantation was reported as “seventh‐day syndrome.” The outcome of seventh‐day syndrome is extremely poor, and its etiology and management are not still established. We herein reported a seventh‐day syndrome case who was successfully managed by immediate desensitization after liver retransplantation and reviewed by English literature. A 19‐year‐old woman who had underwent the first liver transplantation when she was 2‐year‐old. She developed graft failure due to chronic rejection and was on the waiting list for retransplantation. An evaluation of panel‐reactive antibody showed high positivity, but there were no preformed donor‐specific antibodies. Plasma exchange was performed one‐time just before retransplantation and the mean fluorescence intensity significantly decreased. The second liver was successfully transplanted, and post‐operative course was uneventful. However, on post‐operative day 5, her body temperature elevated and thereafter, her liver enzymes dramatically elevated. We immediately started a desensitization consisted of plasma exchange, intravenous immunoglobulin, and anti‐CD20 antibody. The peak level of AST and ALT was 5799 IU/L and 3960 IU/L, respectively. The pathological findings of liver biopsy revealed some central venous endotheliitis and massive centrilobular hemorrhagic hepatocellular necrosis. These findings were not typical for antibody‐mediated rejection, but the desensitization was effective and liver graft was successfully rescued. The only way to prevent early graft loss due to seventh‐day syndrome is thought to be an immediate decision to start intensive desensitization.