title: [Sequential heart and liver transplantation for familial amyloid polyneuropathy].
abstract: OBJECTIVE
  Combined heart and liver transplantation for familial amyloid polyneuropathy (FAP) is currently the best treatment for patients with cardiomyopathy related to FAP. However, its optimal timing and the possibility of domino liver transplantation in this setting remain under discussion. Most such cases in the medical literature have been performed simultaneously, although many of them have required the use of veno-venous bypass and the majority have not used the liver as a graft for domino liver transplantation.
  
  
  METHODS
  We report 3 cases of non-Val30Met mutation that underwent sequential heart and domino liver transplantation at our institution.
  
  
  RESULTS
  We describe the 3 cases and the medical literature, with special attention to the reason for sequential heart and liver transplantation, the role of transient elastography in this setting, and the feasibility of domino liver transplantation.
  
  
  CONCLUSIONS
  In our experience, combined heart and liver transplantation is a feasible but challenging procedure for patients with FAP. Performing the procedure sequentially rather than simultaneously seems safer and easier, both technically and hemodynamically. More importantly, such an approach allows the use of livers from FAP patients as grafts for domino liver transplantation.
authors.affiliation: Unidad de Trasplante Hepático, Servicio de Cirugía, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, España. Electronic address: 31513llg@comb.cat.
authors.forename: Laura
authors.initials: L
authors.lastname: Lladó
authors.affiliation: Unidad de Trasplante Hepático, Servicio de Cirugía, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, España.
authors.forename: Joan
authors.initials: J
authors.lastname: Fabregat
authors.affiliation: Unidad de Trasplante Hepático, Servicio de Cirugía, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, España.
authors.forename: Emilio
authors.initials: E
authors.lastname: Ramos
authors.affiliation: Unidad de Trasplante Hepático, Servicio de Hepatología, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, España.
authors.forename: Carme
authors.initials: C
authors.lastname: Baliellas
authors.affiliation: Unidad de Trasplante Hepático, Servicio de Cardiología, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, España.
authors.forename: Josep
authors.initials: J
authors.lastname: Roca
authors.affiliation: Unidad de Trasplante Hepático, Servicio de Neurología, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, España.
authors.forename: Carlos
authors.initials: C
authors.lastname: Casasnovas
mesh_terms: D000328:Adult; D028227:Amyloid Neuropathies, Familial / Q000601:surgery*; D017809:Fatal Outcome; D005260:Female; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013997:Time Factors
keywords: Cardiopathy; Cardiopatía; Domino; Dominó; Donación; Donation; Mutación; Mutation; Piggy-back; Polineuropatía; Polyneuropathy