Domino liver transplants for metabolic disorders: Experience with familialamyloidotic polyneuropathy

Background: Shortage of liver donors means that new methods of liver procur ement must be explored. In domino transplantation, organs explanted during transplantation in one patient are transplanted into a second patient. Domi no procedures can be performed with livers from patients having transplanti on for hepatic metabolic disorders that cause systemic disease without affe cting other liver functions. Familial amyloidotic polyneuropathy (FAP) type I is one of these. Study Design: We reviewed the Paul Brousse experience with a domino liver t ransplant program for FAP, hoping to extend the approach to other metabolic disorders. Results: Livers from 10 patients transplanted for FAP type 1 were used for domino transplants to patients with unresectable primary or metastatic live r cancers. There was no perioperative mortality. Neuropathy or cardiomyopat hy did not increase the morbidity of the domino liver explant and transplan t procedures. Morbidity for the domino recipients did not appear to be incr eased. Variant transthyretin was detected in the serum in FAP liver recipie nts, with no immediate clinical consequences. Conclusions: The domino approach is feasible and requires careful planning of the surgical procedures for liver explantation, particularly for the nat ure and site of vascular anastomoses. Domino transplantation of metabolical ly dysfunctional livers creates new categories of potential donors and pote ntial recipients. It raises new ethical, technical, and societal issues. Th e domino approach could be used in several genetic or biochemical disorders now treated by liver transplantation. It has the potential to increase the number of liver grafts available for transplantation. (J Am Coll Surg 1999 ;189:584-593. (C) 1999 by the American College of Surgeons).