| Theme |
Debatable Issues in Living-Donor Liver Transplantation |
| Title |
Domino Liver Transplantation |
| Author |
Hiroyuki Sugo |
Department of Hepato-Biliary-Pancreatic Surgery, Juntendo University School of Medicine |
| Author |
Jiro Yoshimoto |
Department of Hepato-Biliary-Pancreatic Surgery, Juntendo University School of Medicine |
| Author |
Seiji Kawasaki |
Department of Hepato-Biliary-Pancreatic Surgery, Juntendo University School of Medicine |
| [ Summary ] |
Domino liver transplantation (DLT) using an explanted liver from a familial amyloid polyneuropathy (FAP) has become a worldwide strategy that is contributing significantly to the increase in the donor pool. In this procedure, the liver is removed from a patient with FAP and is transplanted into a recepient. DLT from a living donor is more difficult than the procedure from a cadaveric donor in two ways ; there is limited liver volume and short vascular cuffs in the grafts. Native hepatectomy in the FAP patients therefore requires a great deal of care to preserve sufficient length of the vascular structures to ensure satisfactory anastomosis.
DLT involves particular ethical and technical problems. The most important ethical problem in the procedure is the use of a diseased liver with the potential for later development of neuropathy in a second recipient. To minimize the risk of FAP, recipients of domino grafts have been selected from the oldest patients on the waiting list or from high-risk patients who do not qualify for cadaveric liver transplantation. Recipients of domino grafts must accept the rationale for the procedure and should be closely followed for any evidence of amyloidosis. |