Domino liver transplant: influence on the number of donors and transplant coordination

Abstract

The shortage of organs forces coordinators to seek new forms of generating organs for transplantation of the increasing numbers of patients on waiting lists. A recent technique called sequential transplant or domino liver transplant (DLT) allows the transplantation of a patient with chronic liver disease by implantation of a full-size liver derived from a patient with familial amyloidosis polyneuropathy (FAP) who receives a cadaveric graft. Therefore, it is possible to transplant two patients with only one cadaveric liver. The present report illustrates the use of this technique for the first time in our country, thereby increasing the number of hepatic transplants by 25%.

Reversibility of Acquired Amyloid Polyneuropathy After Liver Retransplantation

“…Retransplantation was not performed in the other two patients because they were older than 70 years when acquired amyloid neuropathy developed. Several factors were suspected as explaining this early onset neuropathy in DLT recipients described in previous reports (Table ), such as advanced recipient age or an inflammatory reaction after the transplantation procedure, the latter being a known risk factor for amyloidosis . The usual causes of peripheral neuropathy were ruled out before amyloidosis was incriminated as being responsible for the emerging neuropathy.…”

“…Posttransplantation, his immunosuppressive therapy comprised tacrolimus and corticosteroids, which were gradually tapered and then withdrawn 14 months after LT. Recurrence of HBV was prevented by prophylaxis with anti‐HBs immunoglobulin combined with lamivudine in accordance with the practices of our center . No breakthrough of HBV viral load was observed during follow‐up.…”

“…DLT has become an accepted procedure designed to overcome organ shortage problems, and it accounts for more than 16% of liver transplants performed in Portugal . Thus, to date, around 1000 DLT have been performed worldwide, for various indications .…”

Benefits and ethical issues in domino liver transplant

“…Another similar study was conducted in Portugal by Nunes et al and included 41 cases submitted to domino liver transplant, with a median age of 53 years. The main pathology of the liver disease was represented by alcoholic cirrhosis followed by hepatitis C cirrhosis; performing a domino liver transplant leaded to an increase of the number of the grafts with up to 25% in a single center and with up to 16% at national level, while the risk of developing of clinical manifest familial amyloidotic neuropathy seemed to be minimal (11). Moreover, other authors underlined the fact that excellent results might be achieved after domino liver transplantation but special care should be taken in order to prevent the development of post-transplant thrombotic events (11).…”

“…Even if the risk to develop a metabolic disorder after domino liver transplantation seems to be re-duced, the recipient and its family should be carefully informed about these risks and should give their consent in order to proceed to this surgical gesture (11). Moreover, certain authors proposed creating a specific informed consent for such cases (15) through which the domino donor is assured that he will not be exposed to any supplementary risk while the domino receiver is informed about the risk of developing the metabolic disease at a certain moment.…”