No Evidence Of De Novo Amyloidosis In Recipients Of Domino Liver Transplantation: 12 To 40 (Mean 24) Month Follow-Up

Bittencourt, Paulo Lisboa; Couto, Cláudia Alves; Leitão, Rui; Siqueira, Sheila Aparecida Coelho; Farias, Alberto Queiróz; Massarollo, Paulo Celso Bosco; Mies, Sérgio

doi:10.3109/13506120209114822

Cited by 23 publications

(21 citation statements)

References 9 publications

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“…However, mutated TTR is known to be present in the serum of domino recipients as soon as the first day after transplantation. 8 The first study evaluating amyloid deposition in gastroduodenal mucosa was performed by Bittencourt et al 15 Their sample of 7 DLT recipients showed no symptoms of systemic amyloidosis after a short follow-up (mean ¼ 24 months), although this period was probably too short for any firm conclusions to be drawn.…”

Section: Discussionmentioning

confidence: 99%

Risk of transmission of systemic transthyretin amyloidosis after domino liver transplantation

et al. 2010

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Recent reports of the transmission of systemic transthyretin (TTR) amyloidosis after domino liver transplantation (DLT) using grafts from patients with familial amyloid polyneuropathy (FAP) have raised concerns about the procedure. The aim of this study was to evaluate the transmission incidence of systemic TTR amyloidosis after DLT with a complete clinical, neurological, and pathological assessment. At our institution, DLT has been performed 31 times with livers from patients with FAP. Seventeen of the 19 patients still alive in 2008 agreed to enter the study. This cross‐sectional study of this cohort of patients included clinical assessments, rectal biopsy, and electroneuromyography (as well as sural nerve biopsy when it was indicated). The mean follow‐up at the time of the study was 62.6 ± 2.9 months. Clinically, 3 patients complained of weak dysesthesia. When a focused study was performed, 8 patients reported some kind of neurological and/or gastrointestinal disturbance. Six of the rectal biopsy samples showed amyloid deposits (TTR‐positive). Electromyography (EMG) showed signs of mild sensorimotor neuropathy in 3 cases and moderate to severe sensorimotor neuropathy in 1 case. Only 2 of the 4 patients with EMG signs of polyneuropathy showed amyloid deposits in their rectal biopsy samples. Sural nerve biopsy revealed amyloid deposits (TTR‐positive) in all 4 patients with EMG signs of polyneuropathy. Two patients with normal EMG findings had TTR‐positive amyloid deposits in their sural nerve biopsy samples. In conclusion, de novo systemic amyloidosis after DLT may be more frequent and appear earlier than was initially thought. In our opinion, however, the graft shortage still justifies DLT in selected patients, despite the risk of de novo systemic amyloidosis. Sural nerve biopsy with EMG and clinical correlation is mandatory for confirming the disease. Indeed, other causes of neuropathy should be excluded. Liver Transpl 16:1386–1392, 2010. © 2010 AASLD.

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Section: Discussionmentioning

confidence: 99%

Risk of transmission of systemic transthyretin amyloidosis after domino liver transplantation

et al. 2010

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“…In Brazil, seven DLT recipients were followedup. There was no evidence of peripheral or autonomic neuropathy 12-40 months after DLT, and gastrointestinal biopsies showed no signs of de novo amyloid deposits 4-24 months after DLT (9). In Portugal, 15 DLT recipients had skin biopsies performed 1-7 years after DLT and TTR depositions were found in a minority of patients 3 years after transplantation (10).…”

Section: Introductionmentioning

confidence: 99%

“…In Portugal, 15 DLT recipients had skin biopsies performed 1-7 years after DLT and TTR depositions were found in a minority of patients 3 years after transplantation (10). A summary of the previous reports is shown in Table 1 (9)(10)(11)(12)(13). The possibility of de novo amyloidosis as a late complication of DLT is a worrisome issue, and more information is needed to optimize the selection of DLT recipients.…”

Section: Introductionmentioning

confidence: 99%

Long-term consequences of domino liver transplantation using familial amyloidotic polyneuropathy grafts

et al. 2007

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Summary Domino liver transplantation (DLT) using grafts from patients with familial amyloidotic polyneuropathy (FAP) is an established procedure at many transplantation centers. However, data evaluating the long‐term outcome of DLT are limited. The aim of the present study was to analyze the risk of de novo polyneuropathy, possibly because of amyloidosis, and the patient survival after DLT. At our department, 28 DLT using FAP grafts were conducted between January 1997 and December 2005. One patient was twice subjected to DLT. Postoperative neurological monitoring of peripheral nerve function was performed with electroneurography (ENeG) in 20 cases. An ENeG index based on 12 parameters was calculated and correlated to age and/or height. Three patients developed ENeG signs of polyneuropathy 2–5 years after the DLT, but with no clinical symptoms. The 1‐, 3‐ and 5‐year actuarial patient survival in hepatocellular carcinoma (HCC) patients (n = 12) and non‐HCC patients (n = 15) was 67%, 15%, 15% and 93%, 93%, 80%, respectively (P = 0.001). Development of impaired nerve conduction in a proportion of patients may indicate that de novo amyloidosis occurs earlier than previously expected. Survival after DLT was excellent except in patients with advanced HCC.

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“…3 Our team is pleased when good results in domino liver transplantation are published. It is an incentive to perform this type of liver transplantation.…”

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confidence: 99%

“…However, if good results are seen in domino liver transplantation, 3 and if the domino technique is more secure and easy to perform, patients with FAP could be transplanted first, before the sickest patients. If the domino transplantation becomes routine, a FAP liver can be used in elderly patients with cirrhosis without problems and without additional technical difficulty.…”

mentioning

confidence: 99%

The safest way to play domino

2006

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No Evidence Of De Novo Amyloidosis In Recipients Of Domino Liver Transplantation: 12 To 40 (Mean 24) Month Follow-Up

Abstract: Signs and symptoms of FAP do not occur early in recipients of DLT. These livers could therefore be offered to patients suitable for conventional LT, particularly older subjects in whom the event of de novo amyloidosis would seem improbable.

Cited by 23 publications

References 9 publications

Risk of transmission of systemic transthyretin amyloidosis after domino liver transplantation

Risk of transmission of systemic transthyretin amyloidosis after domino liver transplantation

Long-term consequences of domino liver transplantation using familial amyloidotic polyneuropathy grafts

The safest way to play domino

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