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Sanahuja JM, Reverter E, Ruiz Á, Saenz D, Martínez-Ocón J, Vidal J, Jiménez N, Colmenero J, García-Pagan JC, Fondevila C, Garcia-Valdecasas JC, Beltran J, Blasi A. Portal hypertension has no role in perioperative bleeding during liver transplantation with systematic porto-caval shunt. HPB (Oxford) 2023; 25:454-462. [PMID: 36759304 DOI: 10.1016/j.hpb.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND More than a half of patients undergoing liver transplantation (LT) receive intraoperative transfusion. Portal hypertension (PHT) may contribute to perioperative blood loss. We study the relationship between preoperative hepatic venous pressure gradient (HVPG) values and intraoperative transfusion requirements in adult patients undergoing LT. METHODS 160 cirrhotic patients undergoing first elective LT (2009-2019) with an HVPG measurement within the previous 6 months were included. Surgical technique was piggyback with portocaval shunt (PCS). The association of HVPG and other variables with transfusion requirements and blood loss were studied. RESULTS Blood loss (ml/kg) was positively correlated with HVPG, among other variables, but at multivariable analysis it only remained associated with MELD-Na and HCC indication. Regarding RBC transfusion, MELD-Na and hemoglobin were independently associated with the need and magnitude of RBC transfusion. Subanalysis by surgical stage (hepatectomy, anhepatic, neohepatic) and by serial HVPG cut-offs found no clear associations with either bleeding or transfusion. DISCUSSION The severity of PHT plays a minor role on bleeding and transfusion during LT in a contemporary cohort with systematic PCS. Main determinants of transfusion are liver function and baseline hemoglobin, which would seem the suitable goal to optimize transfusion in LT.
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Affiliation(s)
- Josep M Sanahuja
- Anaesthesiology Department. Hospital Clínic de Barcelona, IDIBAPS (Institut D'Investigacions Biomèdiques August Pi I Sunyer), University of Barcelona, Spain
| | - Enric Reverter
- Liver Unit, Hospital Clínic de Barcelona, IDIBAPS and CIBERehd (Centro de Investigaciones Biomédicas en Red de Enfermedades Hepáticas y Digestivas), Spain
| | - Ángel Ruiz
- Donation and Transplant Procurement Unit, Hospital Clínic de Barcelona, Spain
| | - Denise Saenz
- Anaesthesiology Department. Hospital Clínic de Barcelona, IDIBAPS (Institut D'Investigacions Biomèdiques August Pi I Sunyer), University of Barcelona, Spain
| | - Julia Martínez-Ocón
- Anaesthesiology Department. Hospital Clínic de Barcelona, IDIBAPS (Institut D'Investigacions Biomèdiques August Pi I Sunyer), University of Barcelona, Spain
| | - Julia Vidal
- Anaesthesiology Department. Hospital Clínic de Barcelona, IDIBAPS (Institut D'Investigacions Biomèdiques August Pi I Sunyer), University of Barcelona, Spain
| | - Natalia Jiménez
- Liver Unit, Hospital Clínic de Barcelona, IDIBAPS and CIBERehd (Centro de Investigaciones Biomédicas en Red de Enfermedades Hepáticas y Digestivas), Spain
| | - Jordi Colmenero
- Liver Unit, Hospital Clínic de Barcelona, IDIBAPS and CIBERehd (Centro de Investigaciones Biomédicas en Red de Enfermedades Hepáticas y Digestivas), Spain
| | - Joan C García-Pagan
- Liver Unit, Hospital Clínic de Barcelona, IDIBAPS and CIBERehd (Centro de Investigaciones Biomédicas en Red de Enfermedades Hepáticas y Digestivas), Spain
| | - Constantino Fondevila
- Department of General and Digestive Surgery, Hospital Universitario La Paz and IDIPAZ, CIBERehd, Madrid, Spain
| | - Juan C Garcia-Valdecasas
- Hepatobiliary and Pancreatic Surgery Department, Hospital Clínic, IDIBAPS, University of Barcelona, Spain
| | - Joan Beltran
- Anaesthesiology Department. Hospital Clínic de Barcelona, IDIBAPS (Institut D'Investigacions Biomèdiques August Pi I Sunyer), University of Barcelona, Spain
| | - Annabel Blasi
- Anaesthesiology Department. Hospital Clínic de Barcelona, IDIBAPS (Institut D'Investigacions Biomèdiques August Pi I Sunyer), University of Barcelona, Spain.
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2
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Raghu VK, Carr-Boyd PD, Squires JE, Vockley J, Goldaracena N, Mazariegos GV. Domino transplantation for pediatric liver recipients: Obstacles, challenges, and successes. Pediatr Transplant 2021; 25:e14114. [PMID: 34448327 PMCID: PMC9759994 DOI: 10.1111/petr.14114] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/23/2021] [Accepted: 07/27/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Domino liver transplantation aims to address the need to increase the liver donor supply. In a domino liver transplant, the domino recipient receives the explanted liver from the recipient of a traditional liver transplant. The domino donor typically requires liver transplant to correct a metabolic disorder; the explanted liver thus has a single gene defect but otherwise normal structure and function. METHODS In this review, we detail the history of domino liver transplantation, appropriate domino donor indications, the technical advances to the surgical approach, current outcomes, and future opportunities. RESULTS Development of de novo disease in the domino recipient has relegated adult domino liver transplant to be considered a source of marginal donor livers. However, pediatric domino liver transplant has leveraged certain metabolic disorders, especially maple syrup urine disease, in which the liver enzyme deficiency can be compensated by the systemic presence of sufficient enzyme. Advances in the surgical aspects of assuring adequate length of vasculature have improved the safety of the procedure in both domino donors and recipients. CONCLUSIONS Pediatric domino liver transplant utilizing domino donors with specific metabolic liver diseases should be considered a viable live donor option for children awaiting liver transplant.
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Affiliation(s)
- Vikram K. Raghu
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, UPMC Children’s Hospital Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Peter D. Carr-Boyd
- Hillman Center for Pediatric Transplantation, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James E. Squires
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, UPMC Children’s Hospital Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jerry Vockley
- Division of Medical Genetics, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nicolas Goldaracena
- Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - George V. Mazariegos
- Hillman Center for Pediatric Transplantation, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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3
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Lerut J, Foguenne M, Lai Q, de Ville de Goyet J. Domino-liver transplantation: toward a safer and simpler technique in both donor and recipient. Updates Surg 2020; 73:223-232. [PMID: 32965591 PMCID: PMC7889565 DOI: 10.1007/s13304-020-00886-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/04/2020] [Indexed: 11/29/2022]
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.
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Affiliation(s)
- Jan Lerut
- Institute for Experimental and Clinical Research (IREC), Université Catholique de Louvain (UCL), Avenue Hippocrate 55, 1200, Brussels, Belgium.
| | - Maxime Foguenne
- Institute for Experimental and Clinical Research (IREC), Université Catholique de Louvain (UCL), Avenue Hippocrate 55, 1200, Brussels, Belgium
| | - Quirino Lai
- Liver Transplant Program, Sapienza University of Rome, Rome, Italy.
| | - Jean de Ville de Goyet
- University Pittsburgh Medical Center (UPMC-Italy) at the ISMETT (Istituto Mediterraneo for Trapianto e Terapie ad Alta Specializzazione), IRCCS, Palermo, Italy
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4
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Yamamoto H, Sugawara Y, Sambommatsu Y, Shimata K, Yoshii D, Isono K, Honda M, Yamashita T, Matsushita S, Inomata Y, Hibi T. Living donor domino liver transplantation in a hepatitis C virus/human immunodeficiency virus-coinfected hemophilia patient: a case report. Surg Case Rep 2020; 6:184. [PMID: 32728812 PMCID: PMC7391454 DOI: 10.1186/s40792-020-00944-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background Outcome of the liver transplantation (LT) is worse in hepatitis C virus (HCV)/human immunodeficiency virus (HIV)-coinfected patients compared to patients infected with HCV alone. We report the world’s first case of living donor domino liver transplantation (LDDLT) using a familial amyloid polyneuropathy (FAP) liver in a coinfected recipient with HCV-related liver cirrhosis. Case presentation The recipient was a 43-year-old male with a CD4 cell count of 52/μL and undetectable HIV-RNA at the time of LT. He received a domino liver graft from a 41-year-old female with FAP. No acute cellular rejection or infection occurred after LT. HCV recurrence was confirmed histologically on the posttransplant day 34. Peginterferon/ribavirin therapy resulted in non-response; however, the patient achieved a sustained viral response with sofosbuvir (SOF)/ledipasvir (LDV). Currently, HCV and HIV testing are negative, and symptomatic de novo amyloidosis has not occurred. Conclusions LDDLT allows successful LT in HCV/HIV-coinfected patients; posttransplant HCV recurrence can be successfully treated with anti-viral therapy.
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Affiliation(s)
- Hidekazu Yamamoto
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | - Yasuhiko Sugawara
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yuzuru Sambommatsu
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Keita Shimata
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Daiki Yoshii
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Kaori Isono
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Masaki Honda
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Taro Yamashita
- Department of Neurology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, 860-8556, Japan
| | - Shuzo Matsushita
- Center for AIDS Research, Kumamoto University, Kumamoto, 860-8556, Japan
| | - Yukihiro Inomata
- Department of Surgery, Kumamoto Rosai Hospital, Kumamoto, 866-8533, Japan
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
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Cepeda-Franco C, Marín-Gómez LM, Bernal-Bellido C, Suárez-Artacho G, Álamo-Martínez JM, Padillo-Ruiz FJ, Gómez-Bravo MÁ. Alternative outflow reconstruction in domino liver transplantation. Liver Transpl 2017; 23:1226-1228. [PMID: 28700814 DOI: 10.1002/lt.24816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/14/2017] [Accepted: 06/27/2017] [Indexed: 01/13/2023]
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6
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Di Stefano C, Milazzo V, Milan A, Veglio F, Maule S. The role of autonomic dysfunction in cirrhotic patients before and after liver transplantation. Review of the literature. Liver Int 2016; 36:1081-9. [PMID: 27003923 DOI: 10.1111/liv.13126] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 03/15/2016] [Indexed: 02/13/2023]
Abstract
In patients affected by hepatic cirrhosis, autonomic dysfunction is a common finding; usually it is asymptomatic but it may correlate with increased mortality and morbidity before, during and after liver transplant, due to hemodynamic instability in the course of stressful events like sepsis, gastrointestinal bleeding and reperfusion after transplantation surgery. Hyperdynamic circulation and hepatic dysfunction seem to play a role in the pathogenesis of autonomic dysfunction, even if pathophysiological mechanisms are not completely known. We present a revision of previous literature about prevalence, pathophysiological mechanisms, clinical features, and mortality and morbidity of autonomic dysfunction secondary to hepatic cirrhosis.
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Affiliation(s)
- Cristina Di Stefano
- Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Valeria Milazzo
- Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Alberto Milan
- Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Franco Veglio
- Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Simona Maule
- Autonomic Unit and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
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7
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Blasi A, Hessheimer AJ, Beltrán J, Pereira A, Fernández J, Balust J, Martínez-Palli G, Fuster J, Navasa M, García-Valdecasas JC, Taurá P, Fondevila C. Liver Transplant From Unexpected Donation After Circulatory Determination of Death Donors: A Challenge in Perioperative Management. Am J Transplant 2016; 16:1901-8. [PMID: 26601629 DOI: 10.1111/ajt.13621] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 10/28/2015] [Accepted: 11/03/2015] [Indexed: 01/25/2023]
Abstract
Unexpected donation after circulatory determination of death (uDCD) liver transplantation is a complex procedure, in particular when it comes to perioperative recipient management. However, very little has been published to date regarding intraoperative and immediate postoperative care in this setting. Herein, we compare perioperative events in uDCD liver recipients with those of a matched group of donation after brain death liver recipients. We demonstrate that the former group of recipients suffers significantly greater hemodynamic instability and derangements in coagulation following graft reperfusion. Based on our experience, we recommend a proactive recipient management strategy in uDCD liver transplantation that involves early use of vasopressor support; maintaining adequate intraoperative levels of red cells, platelets, and fibrinogen; and routinely administering tranexamic acid before graft reperfusion.
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Affiliation(s)
- A Blasi
- Anesthesia, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - A J Hessheimer
- General and Digestive Surgery, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - J Beltrán
- Anesthesia, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - A Pereira
- Hemotherapy & Hemostasis, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - J Fernández
- Hepatology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J Balust
- Anesthesia, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - G Martínez-Palli
- Anesthesia, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - J Fuster
- General and Digestive Surgery, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - M Navasa
- Hepatology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J C García-Valdecasas
- General and Digestive Surgery, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - P Taurá
- Anesthesia, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - C Fondevila
- General and Digestive Surgery, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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8
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Long-term Results of Domino Liver Transplantation for Hepatocellular Carcinoma Using the "Double Piggy-back" Technique: A 13-Year Experience. Ann Surg 2016; 262:749-56; discussion 756. [PMID: 26583662 DOI: 10.1097/sla.0000000000001446] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the long-term outcome of liver transplantation (LT) for hepatocellular carcinoma (HCC) with Domino LT (DLT) using the "Double Piggy-back" technique. BACKGROUND DATA DLT using livers from familial amyloidotic polyneuropathy (FAP) patients is a well-described technique and useful for expanding the donor pool. However, data on long-term results for HCC are limited, particularly regarding the use of the "Double Piggy-back" technique. METHODS Between 2001 and 2014, a total of 260 patients undergoing LT for HCC were analyzed from a prospective database. Of those, 114 were submitted to DLT. Comparisons between groups were performed using propensity score matching. RESULTS Median follow-up was 34 months (1-152). Overall and disease-free 5-year survival rates for the whole population were 58% and 56%, respectively. There were 177 (68%) patients within Milan Criteria and an additional 26 (10%) within University of California San Francisco (UCSF) criteria. Patients older than 50 years were more likely to receive an FAP liver [odds ratio (OR) 1.94, confidence interval (CI) 1.02-3.69]. DLT patients had more major complications (23.7% vs 13.0%, P = 0.025). Only patients undergoing DLT presented with piggy-back syndrome (7% vs 0%, P = 0.001). After adjusting for potential confounders, DLT and cadaveric LT had a similar 5-year survival rate (59% vs 44%, respectively, P = 0.117). Thirteen patients (11.4%) evidenced FAP disease but not before 6 years after DLT. CONCLUSIONS DLT for HCC is feasible and achieves equivalent results to cadaveric LT. The benefit of expanding the donor pool must be balanced against higher morbidity and a real risk of disease transmission.
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9
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De la Serna S, Llado L, Ramos E, Fabregat J, Baliellas C, Busquets J, Secanella L, Pelaez N, Torras J, Rafecas A. Technical options for outflow reconstruction in domino liver transplantation: A single European center experience. Liver Transpl 2015; 21:1051-5. [PMID: 25857709 DOI: 10.1002/lt.24143] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 03/15/2015] [Accepted: 03/30/2015] [Indexed: 02/07/2023]
Abstract
Venous outflow is critical to the success of liver transplantation (LT). In domino liver transplantation (DLT), the venous cuffs should be shared between the donor and the recipient, and the length can be compromised. The aim of this study was to describe and compare the technical options for outflow reconstruction used at our institution. This was a retrospective analysis of 39 consecutive DLT recipients between January 1997 and May 2013. Twenty-seven men and 12 women (mean age, 61.8 ± 4.3 years) underwent LT and consented to receive a liver from a donor with familial amyloid polyneuropathy (FAP). The main indications were hepatocellular carcinoma and hepatitis C virus cirrhosis. All recipients underwent transplantation by a piggyback technique. Liver procurement in the FAP donors was performed with the classic technique in 22 patients and with the piggyback technique in the last 17. In these latter cases, for vascular outflow reconstruction, a cadaveric venous graft was interposed between the hepatic vein (HV) stump of the FAP liver and the recipient HV in 11 cases (28%). Since 2011, we have employed arterial grafts to be interposed between the vessels stumps: a tailored arterial graft in 5 patients and an aortic graft in 1 case. There was no postoperative mortality. Arterial and portal complications presented in 2 (5.1) and 4 patients (10.3), respectively. Postoperative outflow complications (post-LT subacute Budd-Chiari syndrome) occurred in 4 patients, and all of them had received a venous interposed graft for reconstruction. The incidence of outflow complications tended to be higher among patients with venous grafts than those with arterial graft interposition. Overall patient survival at 1, 3, 5, and 10 years was 97%, 79%, respectively. Arterial grafts constitute a feasible and safe option for vascular outflow reconstruction in DLT because they are associated with a relatively low incidence of complications. The recently proposed Bellvitge arterial graft technique should be added to the current range of available surgical modalities.
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Affiliation(s)
- Sofía De la Serna
- Liver Transplantation Unit, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
| | - Laura Llado
- Liver Transplantation Unit, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
| | - Emilio Ramos
- Liver Transplantation Unit, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
| | - Joan Fabregat
- Liver Transplantation Unit, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
| | - Carme Baliellas
- Liver Transplantation Unit, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
| | - Juli Busquets
- Liver Transplantation Unit, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
| | - Lluis Secanella
- Liver Transplantation Unit, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
| | - Nuria Pelaez
- Liver Transplantation Unit, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
| | - Jaume Torras
- Liver Transplantation Unit, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
| | - Antoni Rafecas
- Liver Transplantation Unit, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
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10
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Marcacuzco Quinto AA, Manrique Municio A, Jimenez Romero LC, Loinaz Segurola C, Calvo Pulido J, Justo Alonso I, Garcia-Sesma Perez-F A, Abradelo de Usera M, Cambra Molero F, Caso M O, Moreno Gonzalez E. [Liver transplantation as treatment of familial amyloid polyneuropathy in patients older than 60 years]. Med Clin (Barc) 2015; 144:385-8. [PMID: 24746275 DOI: 10.1016/j.medcli.2014.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Familial amyloid polyneuropathy (FAP) is the most prevalent type of hereditary systemic amyloidosis. It is an autosomal dominant disease characterized by the deposition of an abnormal variant transthyretin. It has a worldwide distribution, with localized endemic areas in Portugal, Sweden and Japan. In Spain there is an endemic focus, located in Mallorca. Liver transplantation is the only curative option for patients with FAP. The aim of this study was to describe the clinical and demographic characteristics of patients transplanted with a diagnosis of PAF. MATERIAL AND METHOD Six patients with PAF underwent liver transplantation between April 1986 and December 2012. RESULTS The mean age was 57.7+16 years, patients of Spanish origin were older than 60 years. All patients had progressive symptoms as mixed polyneuropathy. In 2 patients, combined heart-liver transplants sequentially were performed. Patient survival and graft was 80% at one, 3 and 5 years. CONCLUSIONS The only effective treatment for etiologic PAF is liver transplantation. Early detection is the key to the treatment and control, avoiding the irreversible organ damage.
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Affiliation(s)
- Alberto A Marcacuzco Quinto
- Servicio de Cirugía General C y Trasplante de Órganos Abdominales, Hospital Universitario 12 de Octubre, Madrid, España.
| | - Alejandro Manrique Municio
- Servicio de Cirugía General C y Trasplante de Órganos Abdominales, Hospital Universitario 12 de Octubre, Madrid, España
| | - Luis C Jimenez Romero
- Servicio de Cirugía General C y Trasplante de Órganos Abdominales, Hospital Universitario 12 de Octubre, Madrid, España
| | - Carmelo Loinaz Segurola
- Servicio de Cirugía General C y Trasplante de Órganos Abdominales, Hospital Universitario 12 de Octubre, Madrid, España
| | - Jorge Calvo Pulido
- Servicio de Cirugía General C y Trasplante de Órganos Abdominales, Hospital Universitario 12 de Octubre, Madrid, España
| | - Iago Justo Alonso
- Servicio de Cirugía General C y Trasplante de Órganos Abdominales, Hospital Universitario 12 de Octubre, Madrid, España
| | - Alvaro Garcia-Sesma Perez-F
- Servicio de Cirugía General C y Trasplante de Órganos Abdominales, Hospital Universitario 12 de Octubre, Madrid, España
| | - Manuel Abradelo de Usera
- Servicio de Cirugía General C y Trasplante de Órganos Abdominales, Hospital Universitario 12 de Octubre, Madrid, España
| | - Felix Cambra Molero
- Servicio de Cirugía General C y Trasplante de Órganos Abdominales, Hospital Universitario 12 de Octubre, Madrid, España
| | - Oscar Caso M
- Servicio de Cirugía General C y Trasplante de Órganos Abdominales, Hospital Universitario 12 de Octubre, Madrid, España
| | - Enrique Moreno Gonzalez
- Servicio de Cirugía General C y Trasplante de Órganos Abdominales, Hospital Universitario 12 de Octubre, Madrid, España
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11
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Carvalho A, Rocha A, Lobato L. Liver transplantation in transthyretin amyloidosis: issues and challenges. Liver Transpl 2015; 21:282-92. [PMID: 25482846 DOI: 10.1002/lt.24058] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 11/26/2014] [Indexed: 12/25/2022]
Abstract
Hereditary transthyretin amyloidosis (ATTR) is a rare worldwide autosomal dominant disease caused by the systemic deposition of an amyloidogenic variant of transthyretin (TTR), which is usually derived from a single amino acid substitution in the TTR gene. More than 100 mutations have been described, with V30M being the most prevalent. Each variant has a different involvement, although peripheral neuropathy and cardiomyopathy are the most common. Orthotopic liver transplantation (OLT) was implemented as the inaugural disease-modifying therapy because the liver produces the circulating unstable TTR. In this review, we focus on the results and long-term outcomes of OLT for ATTR after more than 2063 procedures and 23 years of experience. After successful OLT, neuropathy and organ impairment are not usually reversed, and in some cases, the disease progresses. The overall 5-year survival rate is approximately 100% for V30M patients and 59% for non-ATTR V30M patients. Cardiac-related death and septicemia are the main causes of mortality. Lower survival is related to malnutrition, a longer duration of disease, cardiomyopathy, and a later onset (particularly for males). Deposits, which are composed of a mixture of truncated and full-length TTR (type A) fibrils, have been associated with posttransplant myocardial dysfunction. A higher incidence of early hepatic artery thrombosis of the graft has also been documented for these patients. Liver-kidney/heart transplantation is an alternative for patients with advanced renal disease or heart failure. The sequential procedure, in which ATTR livers are reused in patients with liver disease, reveals that neuropathy in the recipient may appear as soon as 6 years after OLT, and ATTR deposits may appear even earlier. Long-term results of trials with amyloid protein stabilizers or disrupters, silencing RNA, and antisense oligonucleotides will highlight the value and limitations of liver transplantation.
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Antonini TM, Lozeron P, Lacroix C, Mincheva Z, Durrbach A, Slama M, Vibert E, Samuel D, Adams D. Reversibility of acquired amyloid polyneuropathy after liver retransplantation. Am J Transplant 2013; 13:2734-8. [PMID: 23915219 DOI: 10.1111/ajt.12378] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 05/16/2013] [Accepted: 06/02/2013] [Indexed: 01/25/2023]
Abstract
Domino liver transplantation (DLT) has become an accepted procedure designed to address problems with organ limited supply. However, cases of acquired amyloid neuropathy are increasingly being recognized following this procedure. Until now, only one patient had undergone liver retransplantation and follow-up findings were not reported. We describe the case of a 72-year-old patient with partial recovery from acquired amyloid neuropathy following retransplantation with a deceased donor 7 years after DLT performed for end-stage liver disease. His clinical and paraclinical improvement is described, and the impact of this case on the indication for a domino procedure and the challenges linked to retransplantation are discussed.
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Affiliation(s)
- T M Antonini
- AP-HP, Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France; Univ Paris-Sud, UMR-S 785, Villejuif, France; Inserm, Unité 785, Villejuif, France; French National Reference Centre for FAP (NNERF), Le Kremlin Bicêtre, F-94275, France
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Kitchens WH. Domino liver transplantation: indications, techniques, and outcomes. Transplant Rev (Orlando) 2011; 25:167-77. [PMID: 21803558 DOI: 10.1016/j.trre.2011.04.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 04/26/2011] [Indexed: 02/07/2023]
Abstract
The long-term shortage of livers available for transplantation has spurred the development of many strategies to bolster the donor organ supply. One particularly innovative strategy is domino liver transplantation in which a select group of liver transplant recipients can donate their explanted native livers for use as liver grafts in other patients. Several hereditary metabolic diseases (such as familial amyloid polyneuropathy, maple syrup urine disease, and familial hypercholesterolemia) are caused by aberrant or deficient protein production in the liver, and these conditions can be cured with an orthotopic liver transplant. Although their native livers eventually caused severe systemic disease in these patients, these livers are otherwise structurally and functionally normal, and they have been used successfully in domino liver transplants for the past 15 years. This article will review the indications for donating or receiving a domino liver transplant, the surgical techniques necessary to perform these transplants, as well as the recently revealed long-term outcomes and risks of domino transplantation.
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Tincani G, Hoti E, Andreani P, Ricca L, Pittau G, Vitale V, Blandin F, Adam R, Castaing D, Azoulay D. Operative risks of domino liver transplantation for the familial amyloid polyneuropathy liver donor and recipient: a double analysis. Am J Transplant 2011; 11:759-66. [PMID: 21446978 DOI: 10.1111/j.1600-6143.2011.03477.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Although domino liver transplantation (LT) is an established procedure, data about the operative risks are limited. This study aimed at evaluating the operative risks of domino LT. Two retrospective analyses were conducted (comparison of familial amyloid polyneuropathy [FAP] liver donors [61 patients] vs. FAP nondonors [39 patients] and FAP liver recipients [61 patients] vs. deceased donor liver recipients [61 patients]). First analysis showed a 60-day mortality of 6.6% for FAP donors and 7.7% for FAP nondonors (p = 1.0). No patient developed primary graft nonfunction. Acute rejection was higher in FAP nondonors compared to FAP donors (38.5% vs. 13.1%). Both groups had similar vascular and biliary complication rates. ICU stay was similar, whereas total hospitalization was longer for FAP nondonors. Both groups had similar 1- and 5-year patient and graft survival rates (83.4% vs. 87.2%, and 79.8% vs. 71.8%, p = 0.7) and (83.3% vs. 87.2%, and 79.1% vs.71.8%, p = 0.7). The second analysis showed a 1.6% mortality for FAP liver recipients vs. 3.2% of the control group (p = 1). Both groups had similar morbidity and technical complication rates (18.0% vs. 13.1%, p = 0.45) and (0.18 vs. 0.15, p = 0.65). The domino procedure does not add any risk to FAP donor or recipient. It increases the organ pool allowing transplantation of marginal recipients who otherwise are denied deceased donor liver transplantation.
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Affiliation(s)
- G Tincani
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
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