title: Domino liver transplants for metabolic disorders: experience with familial amyloidotic polyneuropathy.
abstract: BACKGROUND
  Shortage of liver donors means that new methods of liver procurement must be explored. In domino transplantation, organs explanted during transplantation in one patient are transplanted into a second patient. Domino procedures can be performed with livers from patients having transplantation for hepatic metabolic disorders that cause systemic disease without affecting other liver functions. Familial amyloidotic polyneuropathy (FAP) type I is one of these.
  
  
  METHODS
  We reviewed the Paul Brousse experience with a domino liver transplant program for FAP, hoping to extend the approach to other metabolic disorders.
  
  
  RESULTS
  Livers from 10 patients transplanted for FAP type 1 were used for domino transplants to patients with unresectable primary or metastatic liver cancers. There was no perioperative mortality. Neuropathy or cardiomyopathy did not increase the morbidity of the domino liver explant and transplant procedures. Morbidity for the domino recipients did not appear to be increased. Variant transthyretin was detected in the serum in FAP liver recipients, with no immediate clinical consequences.
  
  
  CONCLUSIONS
  The domino approach is feasible and requires careful planning of the surgical procedures for liver explantation, particularly for the nature and site of vascular anastomoses. Domino transplantation of metabolically dysfunctional livers creates new categories of potential donors and potential recipients. It raises new ethical, technical, and societal issues. The domino approach could be used in several genetic or biochemical disorders now treated by liver transplantation. It has the potential to increase the number of liver grafts available for transplantation.
authors.affiliation: Centre Hepatobiliaire et Université Paris-Sud, Hôpital Paul Brousse, Villejuif, France.
authors.forename: D
authors.initials: D
authors.lastname: Azoulay
authors.forename: D
authors.initials: D
authors.lastname: Samuel
authors.forename: D
authors.initials: D
authors.lastname: Castaing
authors.forename: R
authors.initials: R
authors.lastname: Adam
authors.forename: D
authors.initials: D
authors.lastname: Adams
authors.forename: G
authors.initials: G
authors.lastname: Said
authors.forename: H
authors.initials: H
authors.lastname: Bismuth
mesh_terms: D000328:Adult; D017772:Amyloid Neuropathies / Q000601:surgery*; D002102:Cadaver; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods* / Q000502:physiology; D008297:Male; D008659:Metabolic Diseases / Q000601:surgery; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology; D011228:Prealbumin / Q000235:genetics; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome
chemical_list: D011228:Prealbumin