Outcomes of Domino Liver Transplantation: A Single Institution's Experience

Marín-Gómez, L.M.; Gómez-Bravo, Miguel-Ángel; Barrera-Pulido, L.; Bellido, C. Bernal; Álamo-Martínez, J.M.; Suárez-Artacho, G.; Díez-Canedo, J. Serrano; Sousa-Martı́n, J.M.

doi:10.1016/j.transproceed.2010.02.012

Cited by 18 publications

(9 citation statements)

References 6 publications

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“…In the case of FAP, the results of DLT are comparable to the results of DDLT 8. The recipient survival rates at 3 months and 1 year with DDLT and DLT are not significantly different 9.…”

Section: Familial Amyloidotic Polyneuropathy (Fap)mentioning

confidence: 69%

Domino liver transplantation: How far can we push the paradigm?

Popescu

Dima

2011

Liver Transpl

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Domino liver transplantation (DLT) has emerged as a strategy for increasing the number of liver grafts available: morphologically normal livers from donors with metabolic diseases can be used for select recipients with hepatocellular carcinoma (usually outside the Milan criteria). Familial amyloidotic polyneuropathy (FAP) is the most common indication for DLT. When FAP patients are involved in DLT, the indications and outcomes are clear and good, although de novo FAP development within various periods of time has been described in DLT recipients of FAP livers. With the increasing need for organs, livers explanted from patients with rare metabolic diseases, such as primary hyperoxaluria (PH), acute intermittent porphyria (AIP), maple syrup urine disease (MSUD), and homozygous familial hypercholesterolemia (HFHC), are being used for DLT. However, insufficient data about the use of livers from patients with these rare metabolic diseases are available. In this review, we focus on the latter disorders. PH is not a good indication for DLT because recipients of PH livers develop hyperoxaluria and early acute renal failure. AIP also seems to be a debatable indication for DLT because of the rapid development of neurotoxicity in AIP liver recipients. However, the outcomes of DLT with HFHC and MSUD liver grafts (which include the risk of the de novo development of these genetic diseases) are promising. For rare metabolic liver diseases to be established as indications for DLT, more reports and studies are needed. Liver Transpl 18:22-28, 2012. V C 2011 AASLD. Because of the organ shortage and the increasing number of patients on the waiting list for liver transplantation (LT), alternative techniques such as split LT and living donor LT have been developed. Another possible way of increasing the pool of liver grafts is the use of marginal livers. Domino liver transplantation (DLT) has emerged as a strategy for increasing the number of liver grafts available: explanted organs are used for select patients. Except for the production of an abnormal protein or enzyme, these livers are morphologically normal and fully functional. Additionally, the metabolic diseases of the donors usually should not produce symptoms in the DLT recipients for many years. In comparison with deceased donor liver transplantation (DDLT), DLT should not expose the recipients or the donors to any significant additional operative risks. The survival of the recipients should be as good as it would be with DDLT, and the morbidity and mortality of the donors must be kept to a minimum. 1 So that as much information as possible could be gathered about DLT, an international registry (the Domino Liver Transplant Registry) was created in 1999 as an extension of the already existing Familial Amyloidotic Polyneuropathy World Transplant Registry. 2 According to this registry, DLT had been performed 790 times by December 31, 2009. 3

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“…In the case of FAP, the results of DLT are comparable to the results of DDLT 8. The recipient survival rates at 3 months and 1 year with DDLT and DLT are not significantly different 9.…”

Section: Familial Amyloidotic Polyneuropathy (Fap)mentioning

confidence: 69%

Domino liver transplantation: How far can we push the paradigm?

Popescu

Dima

2011

Liver Transpl

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“…Domino liver transplantation is a more commonly utilized option in patients who receive a DDLT for FAP. Upon receiving a liver transplant, FAP patients become DLT donors, and institutions have reported success in both the FAP patients and the explanted liver recipients . This anecdotal work has demonstrated that patients with hereditary metabolic diseases that receive LT's can be DLT donors, providing a viable alternative to DDLT.…”

Section: Discussionmentioning

confidence: 99%

“…In a large retrospective study of patients undergoing LT for hepatocellular carcinoma (HCC), the incidence of major complications was higher among patients receiving DLT explants than among patients receiving DDLT, although patient survival was similar between the two groups . Another single‐center analysis and several case reports have reported successful outcomes of patients receiving a DLT explant for a wide range of patient demographics and indications for LT .…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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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.

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“…Moreover, in certain centers it has been proposed that retransplantation from cadaveric donor should be considered if the receiver of a domino graft survives more than five years (12,13). Once again this procedure proves to be an ethical one; in this way performing a domino transplant increases the life span of a patient who could otherwise die on the waiting list and offers him the chance to be submitted to retransplantation after a certain period of time, when a graft from a deceased donor is available (14).…”

Section: Ethical Aspects Of Domino Transplantationmentioning

confidence: 99%

Benefits and ethical issues in domino liver transplant

Bacalbaşa¹,

Bălescu²,

Croitoru³

et al. 2019

Ro Med J.

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Due to the permanent discordance between the number of available liver grafts and the number of cases on the waiting lists, attention was focused on developing different solutions in order to increase the number of grafts. Once the technique of living donor has been proposed, the number of grafts increased but the gap between the number of available grafts and the cases on the waiting list is still significant. Therefore attention was focused on finding out other solutions such as splitting the graft or performing a domino liver transplant. The procedure of domino transplant consists of harvesting a graft from a young patient with metabolic disorders in which a healthy graft will be used and implants it to a marginal receiver. The method seems to associate minimal risks for the marginal donor to develop the metabolic disorder especially if the donor suffers from familial amyloid polyneuropathy; however, ethical issues in such cases are obvious. The aim of this paper is to analyse both the benefits of domino liver transplant and the ethical issues of the procedure.

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Outcomes of Domino Liver Transplantation: A Single Institution's Experience

Cited by 18 publications

References 6 publications

Domino liver transplantation: How far can we push the paradigm?

Domino liver transplantation: How far can we push the paradigm?

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

Benefits and ethical issues in domino liver transplant

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