Domino split-liver transplantation from a living donor: Case reports of insitu and ex situ splitting

The liver from a patient with familial amyloid polyneuropathy (FAP) schedul ed for living donor liver transplantation can be split and transplanted int o 2 adult patients with end-stage liver disease. We have performed this pro cedure, called domino split transplantation, twice. The native liver was sp lit in situ in 1 patient with FAP and ex situ in the other patient with FAP . The recipients of the livers from the patients with FAP and their living donors are doing well without serious complications. Of the 4 secondary rec ipients, 3 patients survived. Domino split-liver transplantation from a liv ing donor thus appears to be a promising procedure for expansion of the don or pool.