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 etiopath...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 I 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.展开更多
Background and Aims:Coronavirus disease 2019(COVID-19)is a global threat,affecting more than 100 million people and causing over 2 million deaths.Liver laboratory test abnormalities are an extrapulmonary manifestation...Background and Aims:Coronavirus disease 2019(COVID-19)is a global threat,affecting more than 100 million people and causing over 2 million deaths.Liver laboratory test abnormalities are an extrapulmonary manifestation of COVID-19,yet characterization of hepatic injury is incomplete.Our objective was to further characterize and identify causes of liver injury in patients with COVID-19.Methods:We conducted a retrospective cohort study of 551 patients hospitalized with COVID-19 at NewYork-Presbyterian Hospital/Columbia University Irving Medical Center between March 1,2020 and May 31,2020.We analyzed patient demographics,liver laboratory test results,vital signs,other relevant test results,and clinical outcomes(mortality and intensive care unit admission).Results:Abnormal liver laboratory tests were common on hospital admission for COVID-19 and the incidence increased during hospitalization.Of those with elevated serum alanine aminotransferase and/or alkaline phosphatase activities on admission,58.2%had a cholestatic injury pattern,35.2%mixed,and 6.6%hepatocellular.Comorbid liver disease was not associated with outcome;however,abnormal direct bilirubin or albumin on admission were associated with intensive care unit stay and mortality.On average,patients who died had greater magnitudes of abnormalities in all liver laboratory tests than those who survived.Ischemic hepatitis was a mechanism of severe hepatocellular injury in some patients.Conclusions:Liver laboratory test abnormalities are common in hospitalized patients with COVID-19,and some are associated with increased odds of intensive care unit stay or death.Severe hepatocellular injury is likely attributable to secondary effects such as systemic inflammatory response syndrome,sepsis,and ischemic hepatitis.展开更多
文摘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 I 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.
基金National Institute of Diabetes and Digestive and Kidney Disease(No.T35DK93430)to JMB and the National Center for Advancing Translational Sciences(No.UL1TR001873)of the National Institutes of Health to support the Irving Center for Clinical and Translational Research at Columbia UniversityThe content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
文摘Background and Aims:Coronavirus disease 2019(COVID-19)is a global threat,affecting more than 100 million people and causing over 2 million deaths.Liver laboratory test abnormalities are an extrapulmonary manifestation of COVID-19,yet characterization of hepatic injury is incomplete.Our objective was to further characterize and identify causes of liver injury in patients with COVID-19.Methods:We conducted a retrospective cohort study of 551 patients hospitalized with COVID-19 at NewYork-Presbyterian Hospital/Columbia University Irving Medical Center between March 1,2020 and May 31,2020.We analyzed patient demographics,liver laboratory test results,vital signs,other relevant test results,and clinical outcomes(mortality and intensive care unit admission).Results:Abnormal liver laboratory tests were common on hospital admission for COVID-19 and the incidence increased during hospitalization.Of those with elevated serum alanine aminotransferase and/or alkaline phosphatase activities on admission,58.2%had a cholestatic injury pattern,35.2%mixed,and 6.6%hepatocellular.Comorbid liver disease was not associated with outcome;however,abnormal direct bilirubin or albumin on admission were associated with intensive care unit stay and mortality.On average,patients who died had greater magnitudes of abnormalities in all liver laboratory tests than those who survived.Ischemic hepatitis was a mechanism of severe hepatocellular injury in some patients.Conclusions:Liver laboratory test abnormalities are common in hospitalized patients with COVID-19,and some are associated with increased odds of intensive care unit stay or death.Severe hepatocellular injury is likely attributable to secondary effects such as systemic inflammatory response syndrome,sepsis,and ischemic hepatitis.
