DOMINO HEPATIC TRANSPLANTATION USING - THE LIVER FROM A PATIENT WITH FAMILIAL AMYLOID POLYNEUROPATHY

Background, In transplantation, novel methods are required to augment the supply of donor organs. We report the first domino liver transplan t in which a patient with familial amyloid polyneuropathy (FAP) receiv ed an orthotopic split liver graft, and her explanted liver was donate d to another patient. Three successful liver transplants were thus ach ieved from the one cadaver liver. Patients and Methods. A cadaveric do nor liver was split and the left lobe was grafted into a child with bi liary atresia, The right lobe was transplanted into a woman with FAP a ssociated with the transthyretin Met30 variant. Her own otherwise heal thy liver was donated to a patient with cirrhosis and hepatocellular c arcinoma. Results. Fifteen months after transplantation, all three rec ipients are well with normal liver function. The domino recipient deve loped inferior vena cava stricturing at the level of anastomosis after surgery with resultant ascites, requiring dilatation and LeVeen shunt insertion. Serum amyloid P component scintigraphy showed amyloid regr ession in the domino donor and to date has not identified any amyloid deposits in the recipient, who also remains free of tumor recurrence. Conclusions. Domino transplantation using the livers from patients wit h FAP may be justified for patients whose disease condition precludes a long spell on the waiting list, including those with hepatic maligna ncies and those for whom palliation rather than long-term cure is the aim.