Domino-liver transplantation: toward a safer and simpler technique in both donor and recipient
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ORIGINAL ARTICLE
Domino‑liver transplantation: toward a safer and simpler technique in both donor and recipient Jan Lerut1 · Maxime Foguenne1 · Quirino Lai2 · Jean de Ville de Goyet3 Received: 14 May 2020 / Accepted: 4 September 2020 © The Author(s) 2020
Abstract Domino-liver transplantation represents a rare chance to expand the donor liver pool. Fear of putting both donor and recipient at disadvantage has meant that the procedure has not been applied universally. A modification of the original technique which allows both safe procurement of the graft as well as safe implantation of the reconstructed graft in the domino-graft recipient using a 180° rotated, adequately trimmed, free iliaco-caval venous graft is described in detail. Keywords Liver transplantation · Domino-liver transplantation · Venous allograft · Familial amyloidotic neuropathy Abbreviations DLT Domino-liver transplantation FAP Familial amyloidotic polyneuropathy LT Liver transplantation MHV, LHV, RHV Middle, left, right hepatic vein IVC Inferior vena cava VVB Veno-venous bypass
Introduction Domino (or sequential) liver transplantation (DLT) represents an opportunity to expand the liver allograft pool. The first Swedish experiences with liver transplantation (LT) for hereditary transthyretin amyloidosis, also known as familial amyloidotic polyneuropathy (FAP), the high incidence of this disease in Portugal and the structural normality (except for the production of the mutant TTR) of such livers, led * Jan Lerut [email protected] * Quirino Lai [email protected] 1
Institute for Experimental and Clinical Research (IREC), Université Catholique de Louvain (UCL), Avenue Hippocrate 55, 1200 Brussels, Belgium
2
Liver Transplant Program, Sapienza University of Rome, Rome, Italy
3
University Pittsburgh Medical Center (UPMC-Italy) at the ISMETT (Istituto Mediterraneo for Trapianto e Terapie ad Alta Specializzazione), IRCCS, Palermo, Italy
to the development of DLT [1–3]. The concept is based on the knowledge that non-cirrhogenic, liver-based, metabolic diseases such as FAP, maple syrup disease, hyper-homocysteinemia, methylmalonic acidemia, and hypercholesterolemia are not or slowly transmitted to recipients which do not have these inherited traits [4, 5]. Up to December 2019, 2217 LTs were reported to the FAP World Transplant Registry, the Domino-liver Transplant Registry included 1210 (54%) DLT. DLT is normally only used in elderly and/or cancer patients [6, 7]. The non-use of these potentially excellent liver allografts has four reasons: (a) ethical concerns about putting the domino-donor at risk of a more complex surgical procedure and the domino-recipient for a possible disease transmission (reported in 3.3–21% of domino-recipients); (b) fear of technical complications related to a more difficult arterial inflow and venous outflow reconstruction of the domino-allograft; (c) increased logistics linked to the organization of two simultaneous, LT procedures, and finally (d) the (intra-operative) discovery of advanced live
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