Domino-liver transplantation: toward a safer and simpler technique in both donor and recipient

Abstract

Domino-liver transplantation represents a rare chance to expand the donor liver pool. Fear of putting both donor and recipient at disadvantage has meant that the procedure has not been applied universally. A modification of the original technique which allows both safe procurement of the graft as well as safe implantation of the reconstructed graft in the domino-graft recipient using a 180° rotated, adequately trimmed, free iliaco-caval venous graft is described in detail.

Clinical outcomes after transplantation of domino grafts or standard deceased donor livers: a systematic review and meta‐analysis

“…Recently, a 180° rotated, free iliaco‐caval venous graft was used to reconstruct the domino graft outflow, with an also procured common left iliac vein, anastomosed to the right hepatic vein of the domino graft. The common right iliac vein was then anastomosed to the common stump of the domino graft middle and left hepatic vein; ultimately, the cadaveric IVC cuff was connected to the recipients middle and left hepatic veins 35 . Some studies have explored combined domino heart–liver transplantation for FAP with good outcomes 36,37 .…”

“…The common right iliac vein was then anastomosed to the common stump of the domino graft middle and left hepatic vein; ultimately, the cadaveric IVC cuff was connected to the recipients middle and left hepatic veins. 35 Some studies have explored combined domino heart-liver transplantation for FAP with good outcomes. 36,37 However, give the small number of reports, we were not able to analyze and draw robust conclusions in the current study.…”

Successful adult domino living donor liver transplantation in methylmalonic acidemia: case report

“…Our DLT recipients benefited from a shorter waiting time when compared to the deceased donor transplant list, an organ from a younger donor and an organ with lower chance of preservation injury. Both our selected DLT recipients faced a lengthy wait for a LT from the deceased donor pool, and could have been delisted for LT entirely if their HCC had progressed beyond transplant criteria ( 22 , 25 - 27 ).…”

“…During implantation, we had to deal with shorter vessels than normal by partially clamping the caval vein and conserving as much of the hepatic veins, portal vein, and hepatic artery as possible. Caval vein anastomosis was performed using a 180° rotated, adequately trimmed, free iliaco-caval venous graft, creating an inverted venous Y-graft, allowing for transplantation of the domino allograft into the DLT recipient by a conventional end-to-side piggyback technique ( 21 , 22 ). Hepatic arterial anastomosis was performed between donor proper hepatic artery and recipient right hepatic artery.…”

Domino Liver Transplantation: Current Status

“…The isolated M-LHV cuff is double clamped and hepatic veins are then divided close to the liver surface, completing total hepatectomy. The explanted liver is then perfused with preservation solution through the portal vein and the hepatic artery after opening the RHV stapler line (28,29).…”