Outcomes of domino liver transplantation compared to deceased donor liver transplantation: a propensity-matching approach

Abstract

Domino liver transplantation (DLT) utilizes the explanted liver of one liver transplant recipient as a donor graft in another patient. While there may be unique risks associated with DLT, it is unclear if DLT has less favorable long-term outcomes than deceased donor liver transplantation (DDLT). We used a propensity score matching approach to compare the outcomes of DLT recipients to DDLT recipients. The United Network for Organ Sharing (UNOS) registry was queried for patients undergoing DLT or DDLT in 2002-2016. Each DLT recipient was matched to a unique DDLT recipient to compare mortality and graft failure. There were 126 DLT and 62 835 DDLT recipients meeting inclusion criteria. After propensity score matching on recipient pre-transplant characteristics, 123 DLT cases were matched to DDLT controls from the same UNOS region. On stratified Cox proportional hazards regression, DLT incurred no increase in the hazard of mortality [hazard ratio (HR) = 1.4; 95% confidence interval (CI): 0.8, 2.7; P = 0.265] or graft failure (HR = 1.2; 95% CI: 0.7, 2.1; P = 0.556) compared to DDLT. Using a large national registry, a propensity-matched analysis found no increased risk of mortality or graft failure associated with DLT compared to DDLT.

Maple Syrup Urine Disease and Domino Liver Transplantation: When and How?

“…Surgical complication rates were similar to those reported for standard transplantation. These excellent results support recent data from a propensity-matched analysis of the United Network for Organ Sharing registry (1) showing that domino LTs (n = 123) have similar 10-year graft and patient survival rates compared with deceased donor LT. Despite the technically challenging implantation procedure, (5) 2 domino liver grafts of the Eurotransplant series underwent an ex situ split procedure, and the derived 4 partial grafts were successfully transplanted, reflecting excellent MSUD graft quality.…”

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Liver transplantation (LT) for various metabolic diseases, for which most patients have a structurally normal liver, has increased the interest in using explanted organs for domino LT. Domino transplantation was initially explored in patients with familial amyloidotic polyneuropathy (FAP), and it is an effective strategy to increase availability of liver grafts and reduce wait-list mortality and dropout, in particular, for LT candidates with low priority. (1) In FAP, as in other rare metabolic diseases, such as primary hyperoxaluria, acute porphyria, and familial hypercholesterolemia, domino LT did not show convincing results because the graft recipients had a risk of developing early or late symptoms related to the underlying enzymatic defect. (1) In contrast, a liver from a patient with maple syrup urine disease (MSUD), a disorder in which the liver does not properly metabolize branched-chain amino acids, can be safely transplanted in a non-MSUD individual because the missing enzyme branched-chain alpha-keto acid dehydrogenase complex is sufficiently expressed in other tissues.

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“…Liver transplantation (LT) for various metabolic diseases, for which most patients have a structurally normal liver, has increased the interest in using explanted organs for domino LT. Domino transplantation was initially explored in patients with familial amyloidotic polyneuropathy (FAP), and it is an effective strategy to increase availability of liver grafts and reduce wait‐list mortality and dropout, in particular, for LT candidates with low priority …”

“…In FAP, as in other rare metabolic diseases, such as primary hyperoxaluria, acute porphyria, and familial hypercholesterolemia, domino LT did not show convincing results because the graft recipients had a risk of developing early or late symptoms related to the underlying enzymatic defect . In contrast, a liver from a patient with maple syrup urine disease (MSUD), a disorder in which the liver does not properly metabolize branched‐chain amino acids, can be safely transplanted in a non‐MSUD individual because the missing enzyme branched‐chain alpha‐keto acid dehydrogenase complex is sufficiently expressed in other tissues .…”

Do you really know what you get: the benefits and doubts of domino liver transplantation

“…Patients with an age under 12 years at LT, with high urgency status (UNOS Status 1) and missing data were excluded. During this 15‐year period, 126 DLT were registered compared to 62 835 deceased donor liver transplantation (DDLT) (split grafts and donation after cardiac death (DCD) grafts were excluded) . Thus, in the US, domino grafts accounted for approximately 0.2% of all transplants.…”