Livers from patients with apolipoprotein A-I amyloidosis are not suitable as "domino" donors

Orthotopic liver transplantation, by eliminating the major site of amyloido genic protein synthesis, is currently the only definitive treatment of most hereditary amyloidoses. Because of the minimal parenchymal involvement, th e explanted livers from familial amyloidotic polyneuropathy (FAP) patients have been transplanted into non-FAP patients in a "domino" fashion. The aim of this study was to evaluate the extent of amyloid deposits in explanted livers from two patients with apolipoprotein A-I amyloidosis, with the Arg2 6 mutation, to determine their suitability as domino donors. A detailed his tologic review of the explanted livers from two patients was performed and assessed for the extent of amyloid deposition by routine and Congo red stai ns. Both patients had identical histopathologic features. The liver parench ymal involvement was strikingly severe. Large patches of amyloid separated hepatic cords, with accentuation around the central veins. Ah portal triads were consistently and markedly involved with amorphous eosinophilic deposi ts within the connective tissue compressing the bile ducts and vascular str uctures. Hilar vessels had patchy deposits. No involvement of hilar nerve b ranches was seen. The hepatic parenchyma is extensively involved in heredit ary Apolipoprotein A-I amyloidosis, with the Arg26 mutation. These livers, removed at orthotopic liver transplantation, are not suitable for domino do nation.