Domino liver transplantation from a living related donor

Background. Although domino liver transplantations (OLT) from cadaveric don ors have been performed in about 50 cases since 1995, only one case in the Japanese literature has been reported on a domino OLT from a living related donor. The difficulties of the later surgery Lie in the small size of the graft volume and the short length of the vascular cuffs in the graft. Methods. The left lobe graft was procured from a 43-year-old younger brothe r of a familial amyloidotic polyneuropathy (FAP) patient. Next, the left lo be graft (510 g, 44% of the estimated standard liver volume of the FAP pati ent) was implanted into the 48-year-old female FAP patient, At surgery for the FAP patient, a sufficient length of the vascular cuffs was secured by a n extended left lobe resection, although the right lobe graft mas able to m aintain sufficient vascular cuffs. The right lobe graft (720 g, 54% of the recipient's estimated standard liver volume) was then implanted in the 43-y ear-old male patient with liver cirrhosis and hepatocellular carcinoma (sta ge IV-A). Results. The two recipients were discharged from the hospital I month after OLT. At 7 months after OLT, they are both doing well and the domino recipi ent is free of any tumor recurrence. Conclusion, A domino OLT from the livi ng related donor can therefore be done safely when careful attention is pai d to the graft volume and the length of the vascular cuffs for anastomosis.