肝移植术后疑似第7天综合征的灾难性后果：病例报告及文献回顾。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-09-01 DOI:10.1016/j.transproceed.2025.07.023

Xiao Wang , Nianwei Xing , Qiang Yang , Peng Ding , Yingdong Du

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引用次数: 0

摘要

背景：第7天综合征（Seventh-Day Syndrome, 7DS）是肝移植术后早期严重并发症之一，病情恶化迅速，病死率高。这种罕见病例的发病机制尚不清楚，缺乏有效的干预措施。本研究描述了一名高度疑似7DS患者最终因肝功能衰竭死亡的整个诊断和治疗过程。在快速发展的信息技术时代，我们建议根据临床信息，探索潜在的独立危险因素，建立有效的预警模型，以辅助临床决策。方法：一名52岁的肝脏恶性肿瘤复发患者在匹配肝源后行肝移植。术后病理结果证实HCC和肝硬化。综合评价既往治疗史、检查结果、手术方式及术后治疗情况。结果：患者术后恢复顺利，术后第6天出现发热。随后，肝酶水平急剧升高，抗免疫排斥治疗无效。超声检查显示门静脉流速明显降低，甚至无血流信号。这些与先前报道的临床表现一致，也符合目前提出的免疫损伤机制和缺血性损伤理论。7DS的治疗包括类固醇脉冲治疗、胸腺球蛋白、静脉注射免疫球蛋白和血浆交换治疗。不幸的是，由于移植物功能迅速且不可逆的损害导致肝功能衰竭，患者最终因无法再移植而死亡。结论：7DS是lt后一种罕见的、高致死率的早期严重并发症，由于发病机制不明确、病情进展快、病例差异大，给预防、诊断和治疗带来了重大挑战。利用大数据分析技术识别潜在的危险因素，建立7DS的诊断和治疗预警系统，可以提高未来的临床决策能力。

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Catastrophic Outcome of Suspected Seventh-Day Syndrome After Liver Transplantation: Case Report and Literature Review

Background

Seventh-Day Syndrome (7DS) is one of the early serious complications after liver transplantation (LT) with rapid deterioration and high mortality. The pathogenesis of such rare cases has not been clarified and effective intervention measures are lacking. This study describes the entire diagnosis and treatment process of a highly suspected 7DS patient, who ultimately died due to liver failure. In the rapidly developing information age of technology, we recommend exploring potential independent risk factors and establishing effective warning models based on clinical information to assist in clinical decision-making.

Methods

A 52-year-old patient with a recurrence of liver malignancy underwent LT after matching the liver source. The postoperative pathological results confirmed HCC and cirrhosis. Previous treatment history, test and examination results, surgical procedure, and postoperative treatments were evaluated comprehensively.

Results

The patient initially recovered smoothly after surgery, but developed a fever on postoperative day 6. Subsequently, liver enzyme levels sharply increased, and anti-immune rejection therapy was ineffective. Ultrasound examination showed a significant decrease in portal vein velocity or even no blood flow signal. These were consistent with previously reported clinical manifestations and also conformed to the currently proposed mechanisms of immune damage and ischemic injury theory. Treatment of the 7DS included steroid pulse therapy, thymoglobulin, intravenous immunoglobulin, and plasma exchange therapy. Unfortunately, with the rapid and irreversible damage to the graft function leading to liver failure, the patient ultimately died due to no chance of retransplantation.

Conclusion

7DS is a rare and highly lethal early serious complication after LT. Due to the unclear pathogenesis, rapid disease progression, and differences in cases, it presents significant challenges for prevention, diagnosis, and treatment. Utilizing big data analysis technology to identify potential risk factors and develop a warning system for the diagnosis and treatment of 7DS may enhance clinical decision-making in the future.

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.