Domino liver transplantation

Domino liver transplantation

Domino LT involves transplanting a liver from a patient with metabolic disease who needs LT into a patient with end-stage liver disease with the expectation that the recipient will not develop the metabolic syndrome or the recurrent syndrome will have minimal e ff ect. Several hereditary metabolic diseases such as familial amyloid polyneuropathy (FAP), maple syrup urine disease and familial hypercholesterolaemia are caused by aberrant or deficient protein production in the liver, and these conditions can be cured with an orthotopic LT . Although their native livers eventually caused severe systemic disease in these patients, these livers are otherwise structurally and functionally normal, and hence used as domino into those with end-stage liver failure. A typical example of domino LT is the use of a liver from a patient with FAP to a patient who is outside transplant criteria for liver malignancy . Even if they develop amyloidosis, it would take 10–20 years for the disease to become symptomatic in these recipients. If they have no recurrence of tumour and become symptomatic from FAP in the future they can be o ff ered a retransplant without the risk of recurrence of malignancy .