Can livers removed from patients with FAP be used in domino transplants?

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A shortage of liver donors has prompted exploration of new ways to obtain livers. In domino transplantation, an organ removed from one patient during transplantation is transplanted into a second patient. This can be done with livers from patients undergoing transplantation for hepatic metabolic disorders that cause systemic disease without affecting other liver functions. Familial amyloidotic polyneuropathy (FAP) type I is one such disorder.

Researchers reviewed the Paul Brousse experience with a domino liver transplant program for FAP, hoping to extend the approach to other metabolic disorders. 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 morbidity associated with the domino liver removal and transplantation procedures. Morbidity in domino recipients did not appear to be increased. Variant transthyretin was detected in the serum of recipients of FAP livers, with no immediate clinical consequences.

The authors concluded that the domino approach is feasible and requires careful planning of liver removal, particularly the nature and site of vascular anastomoses. Domino transplantation of metabolically dysfunctional livers creates new categories of potential donors and recipients. It also raises new ethical, technical, and societal issues. The approach could be used in several genetic or biochemical disorders now treated by liver transplantation, and it has the potential to increase the number of liver grafts available for transplantation.