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Parente A, Milana F, Hajibandeh S, Hajibandeh S, Tirotta F, Cho HD, Kasahara M, Kim KH, Schlegel A. Clinical outcomes after transplantation of domino grafts or standard deceased donor livers: a systematic review and meta-analysis. J Gastroenterol Hepatol 2024; 39:620-629. [PMID: 38228293 DOI: 10.1111/jgh.16476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 11/01/2023] [Accepted: 12/18/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND AND AIM Domino liver transplantation (DLT) utilizes otherwise discarded livers as donor grafts for another recipients. It is unclear whether DLT has less favorable outcomes compared to deceased donor liver transplantation (DDLT). We aimed to assess the outcomes of DLT compared to DDLT. METHODS MEDLINE, Embase, and Web of Science database were searched to identify studies comparing outcomes after DLT with DDLT. Data were pooled using random-effects modeling, evaluating odds ratios (OR) or mean difference (MD) for outcomes including waiting list time, severe hemorrhage, intensive care unit (ICU), length hospital stay (LOS), rejection, renal, vascular, and biliary events, and recipient survival at 1, 3, 5, and 10 years. RESULTS Five studies were identified including 945 patients (DLT = 409, DDLT = 536). The DLT recipients were older compared to the DDLT group (P = 0.04), and both cohorts were comparable regarding lab MELD, hepatocellular carcinoma, and waitlist time. There were no differences in vascular (OR: 1.60, P = 0.39), renal (OR: 0.62, P = 0.24), biliary (OR: 1.51, P = 0.21), severe hemorrhage (OR: 1.09, P = 0.86), rejection (OR: 0.78, P = 0.51), ICU stay (MD: 0.50, P = 0.21), or LOS (MD: 1.68, P = 0.46) between DLT and DDLT. DLT and DDLT were associated with comparable 1-year (78.9% vs 80.4%; OR: 1.03, P = 0.89), 3-year (56.2% vs 54.1%; OR: 1.35, P = 0.07), and 10-year survival (6.5% vs 8.5%; OR: 0.8, P = 0.67) rates. DLT was associated with higher 5-year survival (41.6% vs 36.4%; OR: 1.70; P = 0.003) compared to DDLT, which was not confirmed at sensitivity analysis. CONCLUSION This meta-analysis of the best available evidence (Level 2a) demonstrated that DLT and DDLT have comparable outcomes. As indications for liver transplantation expand, future high-quality research is encouraged to increase the DLT numbers in clinical practice, serving the growing waiting list candidates, with the caveat of uncertain de novo disease transmission risks.
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Affiliation(s)
- Alessandro Parente
- Division of Hepatobiliary and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Flavio Milana
- Division of Hepatobiliary and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Shahin Hajibandeh
- Department of Hepatobiliary and Pancreatic Surgery, University Hospital Coventry, Coventry, UK
| | - Shahab Hajibandeh
- Department of Hepatobiliary and Pancreatic Surgery, University Hospital of Wales, Cardiff, UK
| | - Fabio Tirotta
- Department of Surgery, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Trust, Birmingham, UK
| | - Hwui-Dong Cho
- Division of Hepatobiliary and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Mureo Kasahara
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Ki-Hun Kim
- Division of Hepatobiliary and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Andrea Schlegel
- Transplantation Center, Digestive Disease and Surgery Institute, Department of Immunology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
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2
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Rangaswamy B, Hughes CB, Sholosh B, Dasyam AK. Unconventional Strategies for Solid Organ Transplantation and Special Transplantation Scenarios. Radiol Clin North Am 2023; 61:901-912. [PMID: 37495296 DOI: 10.1016/j.rcl.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Solid organ transplantation is the only long-term therapeutic option for patients with end-organ failure but cadaveric and living donor transplant pools are unable to meet the demand for organ transplantation. Newer techniques, innovative strategies and altruistic donors can help bridge this wide gap between the number of organ donors and recipients. Domino liver transplantation, paired organ donation, and ABO incompatible transplants are some of the ways to ensure increased transplant organ availability. Split liver transplantation and ex vivo liver resection and auto transplantation are considered surgically challenging but are being done at tertiary transplant centers.
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Affiliation(s)
| | - Christopher B Hughes
- Department of Surgery, Liver Transplantation at the Thomas E. Starzl Transplantation Institute, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Biatta Sholosh
- Department of Radiology, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Anil K Dasyam
- Department of Radiology, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
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3
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Ball HA, Stevens J, Gillmore JD. Peripheral neuropathy secondary to a 'domino' liver transplant: a case report. J Med Case Rep 2023; 17:291. [PMID: 37381065 DOI: 10.1186/s13256-023-04001-0] [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: 05/17/2022] [Accepted: 05/22/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Peripheral neuropathy caused by amyloidosis is one of the well-recognised sequelae of mutations in the transthyretin gene (TTR). CASE PRESENTATION We describe a case of peripheral neuropathy in a White British 74 year old man with wild-type TTR, 8 years following receipt of a 'domino' liver transplant (from a donor with a TTR mutation). The clinical phenotype and neurophysiology, coupled with presence of ATTR amyloid deposits on fat biopsy, established the diagnosis of ATTR amyloid neuropathy, as a consequence of receipt of a variant-TTR secreting liver. A nerve biopsy was not clinically appropriate for this patient. Such cases are rare since recipients of such livers are typically restricted to people whose natural lifespan is unlikely to stretch into the anticipated symptomatic period of ATTR amyloidosis. However, novel "gene silencing" therapeutics are now available which can dramatically alter the course of this disorder, by reducing the proportion of abnormal proteins. CONCLUSIONS This represents a rare but predictable iatrogenic side effect, and doctors should be aware of this eventuality occurring in a shorter time span than previously anticipated.
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Affiliation(s)
- Harriet A Ball
- North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury-On-Trym, Bristol, BS10 5NB, UK.
- Bristol Medical School, University of Bristol, Bristol, UK.
| | - James Stevens
- North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury-On-Trym, Bristol, BS10 5NB, UK
- Bristol Medical School, University of Bristol, Bristol, UK
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4
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Tsamis KI, Mytilinaios D, Heneghan M, Gillmore JD, Gilbertson JA, Giannopoulos S, Sarmas I, Konitsiotis S. Treatment of acquired transthyretin amyloidosis in domino liver transplantation. Clin Transplant 2023; 37:e14822. [PMID: 36128766 PMCID: PMC10078410 DOI: 10.1111/ctr.14822] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/29/2022] [Accepted: 09/10/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Domino liver transplantation (DLT) has been commonly used during the last two decades to partly meet the high need for liver transplants. However, the recipients of grafts from patients with noncirrhotic inherited metabolic disorders may ultimately develop metabolic syndrome, and management is usually intricate, being complicated by the underlying initial disorder, other comorbidities, and post-transplantation conditions. CASE We report here the management and the outcome in a patient with acquired transthyretin amyloidosis after DLT and significant comorbidities. Final treatment with a transthyretin gene silencing agent, patisiran, was well tolerated and resulted in remission of the aggravating neurological deficits in a follow-up period of 2 years. CONCLUSIONS The case presented here supports the concept that patisiran can target the hepatocytes producing the mutated transthyretin in acquired transthyretin amyloidosis, as efficiently as in hereditary transthyretin amyloidosis (hATTR), and can be used to treat patients with transthyretin amyloidosis after DLT.
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Affiliation(s)
- Konstantinos I Tsamis
- Faculty of Medicine, Department of Physiology, School of Health Sciences, University of Ioannina, Ioannina, Greece.,Department of Neurology, University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
| | | | - Michael Heneghan
- Hepatology Department, Institute of Liver Studies, King's College Hospital, London, UK
| | - Julian D Gillmore
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, London, UK
| | - Janet A Gilbertson
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, London, UK
| | - Sotirios Giannopoulos
- Department of Neurology, University Hospital of Ioannina, University of Ioannina, Ioannina, Greece.,Second Department of Neurology, National & Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Athens, Greece
| | - Ioannis Sarmas
- Department of Neurology, University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
| | - Spyridon Konitsiotis
- Department of Neurology, University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
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5
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Yamamoto H, Sambommatsu Y, Ishii M, Shimata K, Isono K, Honda M, Sugawara Y, Inomata Y, Hibi T. Surgical Outcomes of Domino Liver Transplantation Using Grafts From Living Donors With Familial Amyloid Polyneuropathy. Liver Transpl 2022; 28:603-614. [PMID: 34989109 DOI: 10.1002/lt.26401] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/29/2021] [Accepted: 12/19/2021] [Indexed: 01/13/2023]
Abstract
Domino liver transplantation (DLT) using grafts from donors with familial amyloid polyneuropathy is an acceptable procedure for expanding the donor pool. The vascular and biliary reconstructions in living donor DLT (LDDLT) are technically demanding, and data on the short-term and long-term surgical outcomes of domino donors and recipients in LDDLT are limited. In this study, we identified 25 domino recipients from our liver transplantation program (1999-2018), analyzed the vascular and biliary reconstructions performed, and evaluated the surgical outcomes, including graft survival. Piggyback technique was adopted in all 25 domino donors. The only surgical complication in domino donors was hepatic vein (HV) stenosis with an incidence rate of 4%. In 22 domino recipients, right HV and middle/left HV were reconstructed separately. A total of 10 recipients had 2 arteries anastomosed, and 18 underwent duct-to-duct biliary anastomosis. HV stenosis and biliary stricture had incidence rates of 8% and 24%, respectively, in the recipients, but none of them developed hepatic artery thrombosis. The 1-year and 5-year graft survival rates were 100% each in the domino donors, and 84.0% and 67.3% in the domino recipients, respectively. In conclusion, LDDLT has acceptable outcomes without increasing the operative risk in donors despite the demanding surgical technique involved.
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Affiliation(s)
- Hidekazu Yamamoto
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Yuzuru Sambommatsu
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Masatsugu Ishii
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Keita Shimata
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Kaori Isono
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Masaki Honda
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Yasuhiko Sugawara
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | | | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
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6
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Grande-Trillo A, Baliellas C, Lladó L, Casasnovas C, Franco-Baux JV, Gracia-Sánchez L, Gómez-Bravo MÁ, González-Vilatarsana E, Caballero-Gullón L, Echeverri E, González-Costello J. Transthyretin amyloidosis with cardiomyopathy after domino liver transplantation: Results of a cross-sectional study. Am J Transplant 2021; 21:372-381. [PMID: 32705768 DOI: 10.1111/ajt.16216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 01/25/2023]
Abstract
Domino liver transplantation (DLT) has been used widely in patients with hereditary amyloid transthyretin (ATTR) amyloidosis. New-onset polyneuropathy in recipients of DLT has been reported, but there are few cases of cardiac involvement reported. We aimed to perform a cross-sectional study for ATTR amyloidosis with cardiomyopathy (ATTR-CM) in DLT recipients. We evaluated 23 living DLT recipients a median of 9 years since DLT at 2 referral centers with a systematic cardiac evaluation, including bone scintigraphy. Median age was 72 years, 91% had hypertension, 35% had diabetes mellitus, 67% had chronic renal failure, and 8 patients (35%) developed new-onset polyneuropathy. Only 13% had a normal electrocardiogram and a normal echocardiography, and most of them showed some conduction disturbance or increase in left ventricular wall thickness, but only 1 patient with a Glu89Lys mutation developed ATTR-CM diagnosed by bone scintigraphy and endomyocardial biopsy. None of the recipients of a DLT with Val30Met mutation showed cardiac involvement by bone scintigraphy. In conclusion, DLT from Val30Met donors seems to be safe regarding the development of ATTR-CM. Evaluation of cardiomyopathy in DLT recipients is challenging due to concomitant comorbidities and in this context, bone scintigraphy can be helpful to evaluate ATTR-CM.
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Affiliation(s)
- Antonio Grande-Trillo
- Advanced Heart Failure and Heart Transplant Unit, Virgen del Rocío University Hospital, Seville, Spain
| | - Carmen Baliellas
- Liver Transplant Unit, Department of Gastroenterology, IDIBELL, Bellvitge University Hospital, Barcelona, Spain.,Multidisciplinary Familial Amyloidosis Unit, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Barcelona, Spain
| | - Laura Lladó
- Multidisciplinary Familial Amyloidosis Unit, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Barcelona, Spain.,Liver Transplant Unit, Department of Surgery, IDIBELL, Bellvitge University Hospital, Barcelona, Spain
| | - Carlos Casasnovas
- Multidisciplinary Familial Amyloidosis Unit, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Barcelona, Spain.,Neuromuscular Unit, Neurology Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Barcelona, Spain
| | - Joaquín V Franco-Baux
- Department of Nuclear Medicine, Virgen del Rocío University Hospital, Seville, Spain
| | - Laura Gracia-Sánchez
- Multidisciplinary Familial Amyloidosis Unit, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Barcelona, Spain.,Department of Nuclear Medicine, PET Unit-IDI, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Barcelona, Spain
| | - Miguel Á Gómez-Bravo
- Hepatobiliary and Liver Transplant Unit, General and Digestive Surgery Department, Virgen del Rocio University Hospital, Seville, Spain
| | - Emma González-Vilatarsana
- Multidisciplinary Familial Amyloidosis Unit, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Barcelona, Spain.,Liver Transplant Unit, Department of Surgery, IDIBELL, Bellvitge University Hospital, Barcelona, Spain
| | - Luis Caballero-Gullón
- Department of Nuclear Medicine, Virgen del Rocío University Hospital, Seville, Spain
| | - Eduardo Echeverri
- Advanced Heart Failure and Heart Transplant Unit, Heart Disease Institute, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Barcelona, Spain
| | - José González-Costello
- Multidisciplinary Familial Amyloidosis Unit, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Barcelona, Spain.,Advanced Heart Failure and Heart Transplant Unit, Heart Disease Institute, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Barcelona, Spain
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7
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Usuku H, Yamamoto E, Nishi M, Komorita T, Takae M, Nishihara T, Oike F, Ishii M, Fujisue K, Sueta D, Araki S, Takashio S, Oda S, Misumi Y, Ueda M, Nakamura T, Kawano H, Soejima H, Sakamoto K, Kaikita K, Ando Y, Matsui H, Tsujita K. Temporal Change in Longitudinal Strain After Domino Liver Transplantation With Liver Grafts Explanted From Patients With Hereditary Amyloidogenic Transthyretin Amyloidosis. Circ Rep 2020; 2:730-738. [PMID: 33693203 PMCID: PMC7937528 DOI: 10.1253/circrep.cr-20-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background:
Using transthoracic echocardiography, including 2D speckle tracking imaging (STI), this study examined cardiac function after domino liver transplantation (DLT) with liver grafts explanted from patients with hereditary amyloidogenic transthyretin amyloidosis. Methods and Results:
In all, 14 patients who underwent DLT at Kumamoto University Hospital and for whom 2D STI information was available were enrolled in the study; time-dependent echocardiographic changes were evaluated in 7. Although left ventricular (LV) systolic and diastolic function did not differ between the pre- and post-DLT periods (mean [±SD] 5.4±1.0 years after DLT), there were significant (P<0.05 for all) increases in the post- vs. pre-DLT period in basal longitudinal strain (LS; −13.4±2.3 vs. −19.3±4.4), relative apical LS index (=apical LS/[basal LS+mid LS]; 0.75±0.20 vs. 0.58±0.08), and LV ejection fraction/global LS (3.91±0.58 vs. 3.06±0.44). Age at the time of DLT was significantly higher in the group with impaired (>−14%) than preserved basal LS (57.2±3.5 vs. 39.6±16.0 years; P<0.05). When control subjects (n=14) were added to the enrolled DLT recipients, multivariable logistic regression analysis revealed that a history of DLT was significantly associated with impaired basal LS (>−14%; odds ratio 28.39, 95% confidence interval 1.89–427.45, P<0.05). Conclusions:
LV systolic and diastolic function was preserved in the long term after DLT. However, 2D STI revealed subtle cardiac dysfunction in DLT recipients, which may be an early manifestation of cardiac amyloidosis.
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Affiliation(s)
- Hiroki Usuku
- Department of Laboratory Medicine, Kumamoto University Hospital
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
- Center of Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, Kumamoto University
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
- Center of Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, Kumamoto University
| | - Masato Nishi
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
- Center of Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, Kumamoto University
| | - Takashi Komorita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
- Center of Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, Kumamoto University
| | - Masafumi Takae
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
- Center of Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, Kumamoto University
| | - Taiki Nishihara
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
- Center of Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, Kumamoto University
| | - Fumi Oike
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
- Center of Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, Kumamoto University
| | - Masanobu Ishii
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Koichiro Fujisue
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
- Center of Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, Kumamoto University
| | - Daisuke Sueta
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
- Center of Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, Kumamoto University
| | - Satoshi Araki
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
- Center of Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, Kumamoto University
| | - Seiji Takashio
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
- Center of Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, Kumamoto University
| | - Seitaro Oda
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University
| | - Yohei Misumi
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University
| | - Taishi Nakamura
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
- Center of Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, Kumamoto University
| | - Hiroaki Kawano
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
- Center of Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, Kumamoto University
| | - Hirofumi Soejima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
- Center of Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, Kumamoto University
| | - Kenji Sakamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
- Center of Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, Kumamoto University
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
- Center of Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, Kumamoto University
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University
| | - Hirotaka Matsui
- Department of Laboratory Medicine, Kumamoto University Hospital
- Department of Molecular Laboratory Medicine, Faculty of Life Sciences, Kumamoto University
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
- Center of Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, Kumamoto University
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8
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Giadone RM, Liberti DC, Matte TM, Rosarda JD, Torres-Arancivia C, Ghosh S, Diedrich JK, Pankow S, Skvir N, Jean JC, Yates JR, Wilson AA, Connors LH, Kotton DN, Wiseman RL, Murphy GJ. Expression of Amyloidogenic Transthyretin Drives Hepatic Proteostasis Remodeling in an Induced Pluripotent Stem Cell Model of Systemic Amyloid Disease. Stem Cell Reports 2020; 15:515-528. [PMID: 32735824 PMCID: PMC7419739 DOI: 10.1016/j.stemcr.2020.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 01/15/2023] Open
Abstract
The systemic amyloidoses are diverse disorders in which misfolded proteins are secreted by effector organs and deposited as proteotoxic aggregates at downstream tissues. Although well described clinically, the contribution of synthesizing organs to amyloid disease pathogenesis is unknown. Here, we utilize hereditary transthyretin amyloidosis (ATTR amyloidosis) induced pluripotent stem cells (iPSCs) to define the contribution of hepatocyte-like cells (HLCs) to the proteotoxicity of secreted transthyretin (TTR). To this end, we generated isogenic, patient-specific iPSCs expressing either amyloidogenic or wild-type TTR. We combined this tool with single-cell RNA sequencing to identify hepatic proteostasis factors correlating with destabilized TTR production in iPSC-derived HLCs. By generating an ATF6 inducible patient-specific iPSC line, we demonstrated that enhancing hepatic ER proteostasis preferentially reduces the secretion of amyloidogenic TTR. These data highlight the liver's capacity to chaperone misfolded TTR prior to deposition, and moreover suggest the potential for unfolded protein response modulating therapeutics in the treatment of diverse systemic amyloidoses.
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Affiliation(s)
- Richard M Giadone
- Center for Regenerative Medicine of Boston University and Boston Medical Center, 670 Albany Street, 2nd Floor, Boston, MA 02118, USA
| | - Derek C Liberti
- Center for Regenerative Medicine of Boston University and Boston Medical Center, 670 Albany Street, 2nd Floor, Boston, MA 02118, USA
| | - Taylor M Matte
- Center for Regenerative Medicine of Boston University and Boston Medical Center, 670 Albany Street, 2nd Floor, Boston, MA 02118, USA
| | - Jessica D Rosarda
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - Celia Torres-Arancivia
- Alan and Sandra Gerry Amyloid Research Laboratory, Amyloidosis Center, Boston University School of Medicine, Boston, MA, USA
| | - Sabrina Ghosh
- Center for Regenerative Medicine of Boston University and Boston Medical Center, 670 Albany Street, 2nd Floor, Boston, MA 02118, USA
| | - Jolene K Diedrich
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - Sandra Pankow
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - Nicholas Skvir
- Center for Regenerative Medicine of Boston University and Boston Medical Center, 670 Albany Street, 2nd Floor, Boston, MA 02118, USA
| | - J C Jean
- Center for Regenerative Medicine of Boston University and Boston Medical Center, 670 Albany Street, 2nd Floor, Boston, MA 02118, USA; The Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - John R Yates
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - Andrew A Wilson
- Center for Regenerative Medicine of Boston University and Boston Medical Center, 670 Albany Street, 2nd Floor, Boston, MA 02118, USA; The Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Lawreen H Connors
- Alan and Sandra Gerry Amyloid Research Laboratory, Amyloidosis Center, Boston University School of Medicine, Boston, MA, USA
| | - Darrell N Kotton
- Center for Regenerative Medicine of Boston University and Boston Medical Center, 670 Albany Street, 2nd Floor, Boston, MA 02118, USA; The Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - R Luke Wiseman
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - George J Murphy
- Center for Regenerative Medicine of Boston University and Boston Medical Center, 670 Albany Street, 2nd Floor, Boston, MA 02118, USA; Section of Hematology and Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
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9
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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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10
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Santopaolo F, Lenci I, Bosa A, Angelico M, Milana M, Baiocchi L. Domino Liver Transplantation: Where are we Now? Rev Recent Clin Trials 2020; 14:183-188. [PMID: 30894112 DOI: 10.2174/1574887114666190320123824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/04/2019] [Accepted: 03/15/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Domino transplant occurs when a recipient explanted graft is used for a second recipient. INTRODUCTION The first experience came from thoracic surgery by the observation that many patients during heart-lung transplantation actually showed a functional heart that could be employed in other subjects with a good result. RESULTS This concept was then extended to the field of liver transplantation. At present, some patients transplanted for an inborn metabolic disease may be considered as excellent domino liver donors. CONCLUSION The results, limitations, clinical challenges and the donor and recipient features of domino liver transplantation are discussed in this manuscript.
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Affiliation(s)
- Francesco Santopaolo
- Unita Operativa di Epatologia, Policlinico Universitario di "Tor Vergata"; Viale Oxford 81, 00133 Rome, Italy
| | - Ilaria Lenci
- Unita Operativa di Epatologia, Policlinico Universitario di "Tor Vergata"; Viale Oxford 81, 00133 Rome, Italy
| | - Alessandra Bosa
- Unita Operativa di Epatologia, Policlinico Universitario di "Tor Vergata"; Viale Oxford 81, 00133 Rome, Italy
| | - Mario Angelico
- Unita Operativa di Epatologia, Policlinico Universitario di "Tor Vergata"; Viale Oxford 81, 00133 Rome, Italy
| | - Martina Milana
- Unita Operativa di Epatologia, Policlinico Universitario di "Tor Vergata"; Viale Oxford 81, 00133 Rome, Italy
| | - Leonardo Baiocchi
- Unita Operativa di Epatologia, Policlinico Universitario di "Tor Vergata"; Viale Oxford 81, 00133 Rome, Italy
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11
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Schwartzlow C, Kazamel M. Hereditary Transthyretin Amyloidosis: Clinical Presentation and Management Updates. J Clin Neuromuscul Dis 2020; 21:144-156. [PMID: 32073460 DOI: 10.1097/cnd.0000000000000270] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Hereditary transthyretin amyloidosis, once a rare progressive neuropathy and/or cardiomyopathy, is now recognized with increasing worldwide frequency, various phenotypes, and over 130 gene mutations identified to date. This inherited disorder develops as a result of mutated transthyretin amyloid aggregation and systematic deposition throughout the body. With increasing knowledge about the pathophysiology of this disease, new disease-modifying therapies are being developed. In addition to slowing progression, these new agents were found to improve quality of life and reduce the severity of neuropathic symptoms. Two new gene-modifying therapies recently received Food and Drug Administration approval following the positive results from phase III trials. These include an antisense oligonucleotide, inotersen, and small interfering RNA, patisiran, which were reported to reduce the production of transthyretin and had promising safety profiles. Additional novel therapies are being explored with hopes to prolong survival. Therefore, early diagnosis of this treatable disorder has become increasingly important in clinical practice.
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Affiliation(s)
- Coreen Schwartzlow
- Department of Neurology, The University of Alabama at Birmingham, Birmingham, AL
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12
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Misumi Y, Ueda M, Masuda T, Tsuda Y, Nomura T, Okada M, Inoue Y, Tasaki M, Obayashi K, Yamashita T, Ando Y. Characteristics of acquired transthyretin amyloidosis: A case series and review of the literature. Neurology 2019; 93:e1587-e1596. [PMID: 31511348 DOI: 10.1212/wnl.0000000000008360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/16/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To elucidate the clinical characteristics of acquired ATTR amyloidosis after domino liver transplantation (DLT) with liver grafts explanted from patients with hereditary variant ATTR (ATTRv) amyloidosis. METHODS We evaluated the presence of amyloid deposits and clinical symptoms in 30 recipients of domino liver transplants (24 men and 6 women) who underwent DLT with liver grafts explanted from patients with ATTRv amyloidosis. We analyzed symptoms and measures of 7 cases of symptomatic acquired ATTR amyloidosis and compared those with 30 patients with ATTRv amyloidosis who were the domino liver donors. We also reviewed the literature on case studies of acquired ATTR amyloidosis. RESULTS We found amyloid deposition in 13 of our 30 domino liver recipients. A Kaplan-Meier analysis estimated that the median time from DLT to the first detection of amyloid was 8.5 years. In the literature review, the mean time was 7.3 years, with a wide range of 0.5-13 years. Our 7 symptomatic cases and the literature cases with acquired ATTR amyloidosis presented with clinical features that differed from patients with ATTRv amyloidosis who were the domino liver donors. Patients with acquired ATTR amyloidosis showed markedly milder autonomic disturbance, which is one of the main symptoms of ATTRv amyloidosis. CONCLUSIONS Careful monitoring is required for DLT recipients of ATTRv liver grafts because the time from DLT to disease onset has a wide range and the clinical picture of these DLT recipients is distinct from that of liver donors.
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Affiliation(s)
- Yohei Misumi
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan.
| | - Mitsuharu Ueda
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| | - Teruaki Masuda
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| | - Yukimoto Tsuda
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| | - Toshiya Nomura
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| | - Masamitsu Okada
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| | - Yasuteru Inoue
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| | - Masayoshi Tasaki
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| | - Konen Obayashi
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| | - Taro Yamashita
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
| | - Yukio Ando
- From the Department of Neurology, Graduate School of Medical Sciences (Y.M., M.U., T.M., Y.T., T.N., M.O., Y.I., T.Y., Y.A.), and Department of Morphological and Physiological Sciences, Graduate School of Health Sciences (M.T., K.O.), Kumamoto University, Japan
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13
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Puffer RC, Spinner RJ, Bi H, Sharma R, Wang Y, Theis JD, McPhail ED, Poterucha JJ, Niu Z, Klein CJ. Fatal TTR amyloidosis with neuropathy from domino liver p.Val71Ala transplant. NEUROLOGY-GENETICS 2019; 5:e351. [PMID: 31517060 PMCID: PMC6705621 DOI: 10.1212/nxg.0000000000000351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/01/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Ross C Puffer
- Department of Neurosurgery (R.C.P., R.J.S.); Department of Neurology (H.B., R.S., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), China Friendship Hospital, Beijing; Hematology and Oncology (Y.W.); Laboratory Medicine and Pathology (J.D.T., E.D.M.); Gastroenterology and Hepatology (J.P.P.); Laboratory Genetics and Genomics (Z.N., C.J.K.), Mayo Clinic, Rochester, MN
| | - Robert J Spinner
- Department of Neurosurgery (R.C.P., R.J.S.); Department of Neurology (H.B., R.S., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), China Friendship Hospital, Beijing; Hematology and Oncology (Y.W.); Laboratory Medicine and Pathology (J.D.T., E.D.M.); Gastroenterology and Hepatology (J.P.P.); Laboratory Genetics and Genomics (Z.N., C.J.K.), Mayo Clinic, Rochester, MN
| | - Hongyan Bi
- Department of Neurosurgery (R.C.P., R.J.S.); Department of Neurology (H.B., R.S., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), China Friendship Hospital, Beijing; Hematology and Oncology (Y.W.); Laboratory Medicine and Pathology (J.D.T., E.D.M.); Gastroenterology and Hepatology (J.P.P.); Laboratory Genetics and Genomics (Z.N., C.J.K.), Mayo Clinic, Rochester, MN
| | - Rishi Sharma
- Department of Neurosurgery (R.C.P., R.J.S.); Department of Neurology (H.B., R.S., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), China Friendship Hospital, Beijing; Hematology and Oncology (Y.W.); Laboratory Medicine and Pathology (J.D.T., E.D.M.); Gastroenterology and Hepatology (J.P.P.); Laboratory Genetics and Genomics (Z.N., C.J.K.), Mayo Clinic, Rochester, MN
| | - Yucai Wang
- Department of Neurosurgery (R.C.P., R.J.S.); Department of Neurology (H.B., R.S., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), China Friendship Hospital, Beijing; Hematology and Oncology (Y.W.); Laboratory Medicine and Pathology (J.D.T., E.D.M.); Gastroenterology and Hepatology (J.P.P.); Laboratory Genetics and Genomics (Z.N., C.J.K.), Mayo Clinic, Rochester, MN
| | - Jason D Theis
- Department of Neurosurgery (R.C.P., R.J.S.); Department of Neurology (H.B., R.S., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), China Friendship Hospital, Beijing; Hematology and Oncology (Y.W.); Laboratory Medicine and Pathology (J.D.T., E.D.M.); Gastroenterology and Hepatology (J.P.P.); Laboratory Genetics and Genomics (Z.N., C.J.K.), Mayo Clinic, Rochester, MN
| | - Ellen D McPhail
- Department of Neurosurgery (R.C.P., R.J.S.); Department of Neurology (H.B., R.S., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), China Friendship Hospital, Beijing; Hematology and Oncology (Y.W.); Laboratory Medicine and Pathology (J.D.T., E.D.M.); Gastroenterology and Hepatology (J.P.P.); Laboratory Genetics and Genomics (Z.N., C.J.K.), Mayo Clinic, Rochester, MN
| | - John J Poterucha
- Department of Neurosurgery (R.C.P., R.J.S.); Department of Neurology (H.B., R.S., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), China Friendship Hospital, Beijing; Hematology and Oncology (Y.W.); Laboratory Medicine and Pathology (J.D.T., E.D.M.); Gastroenterology and Hepatology (J.P.P.); Laboratory Genetics and Genomics (Z.N., C.J.K.), Mayo Clinic, Rochester, MN
| | - Zhiyv Niu
- Department of Neurosurgery (R.C.P., R.J.S.); Department of Neurology (H.B., R.S., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), China Friendship Hospital, Beijing; Hematology and Oncology (Y.W.); Laboratory Medicine and Pathology (J.D.T., E.D.M.); Gastroenterology and Hepatology (J.P.P.); Laboratory Genetics and Genomics (Z.N., C.J.K.), Mayo Clinic, Rochester, MN
| | - Christopher J Klein
- Department of Neurosurgery (R.C.P., R.J.S.); Department of Neurology (H.B., R.S., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), China Friendship Hospital, Beijing; Hematology and Oncology (Y.W.); Laboratory Medicine and Pathology (J.D.T., E.D.M.); Gastroenterology and Hepatology (J.P.P.); Laboratory Genetics and Genomics (Z.N., C.J.K.), Mayo Clinic, Rochester, MN
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14
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First case report of domino living donor liver transplantation in Korea. TRANSPLANTATION REPORTS 2019. [DOI: 10.1016/j.tpr.2019.100030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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15
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Abstract
Due to the widening gap between supply and demand, patients who need a liver transplant due to metabolic disease may be asked to serve as domino liver donors-to have their native liver transplanted into another candidate. We here analyze the ethical problems surrounding informed consent for the implant and explant procedures in transplant candidates who will serve as domino donors, using the case of a child with maple syrup urine disease. We discuss the need for 2 distinct consent processes separated in time to ensure that potential domino donors (or their surrogates) give a truly voluntary consent. We propose a Domino Donor Advocate-based on the concept of the independent living donor advocate to help the patient and/or his or her surrogates consider the risks, benefits and alternatives. Finally, we evaluate the Organ Procurement and Transplantation Network policy regarding "therapeutic organ donation" and propose several modifications to ensure that the decision by the potential domino donor (and/or his or her surrogate) is voluntary and informed.
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16
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Vollmar J, Schmid JC, Hoppe-Lotichius M, Barreiros AP, Azizi M, Emrich T, Geber C, Schad A, Weyer V, Otto G, Heise M, Mittler J, Birklein F, Lang H, Galle PR, Zimmermann T. Progression of transthyretin (TTR) amyloidosis in donors and recipients after domino liver transplantation-a prospective single-center cohort study. Transpl Int 2018; 31:1207-1215. [PMID: 30091268 DOI: 10.1111/tri.13326] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 03/30/2018] [Accepted: 07/27/2018] [Indexed: 11/30/2022]
Abstract
Liver transplantation (LT) is the first-line therapy in patients with transthyretin (TTR) amyloidosis and progressive familial amyloid polyneuropathy (FAP). Explanted organs from these patients can be used for domino liver transplantation (DLT). After DLT, de novo amyloidosis may develop in domino recipients (DR). Data were collected prospectively in a transplant database. Electroneurography by nerve conduction velocity (NCV), quantitative sensory testing, heart rate variability (HRV), sympathetic skin response, orthostatic reaction (tilt table test), transthoracic echocardiography, cardiac MRI and organ biopsy results were evaluated. The cohort included 24 FAP- (11 Val30Met, 13 nonVal30Met) and 23 DR-patients. DR symptoms referred to post-DLT only, while those of FAP patients were both pre- and post-transplantation. Symptoms of TTR-amyloidosis in Val30Met and Non-Val30Met patients pre- and post-LT were similarly distributed. Biopsy-proven de novo amyloidosis occurred in 4/23 DR after a mean observation of 10 years. Analysis for manifestations of amyloidosis only included patients with available 5-year follow-up data (n = 13 FAP, n = 12 DR). Compared to Val30Met FAP patients pre-LT, Val30Met DR patients had better NCV (P = 0.04) and HRV (P = 0.015). In the Non-Val30Met group no differences were found between DR and FAP patients pre-LT. TTR-amyloidosis symptoms showed no differences in FAP patients pre- and 5 years post-LT, irrespective of Val30Met status. In DR patients, de novo amyloidosis occurred earlier than expected. Therefore, recipients for DLT need to be carefully selected and followed.
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Affiliation(s)
- Johanna Vollmar
- I. Department of Internal Medicine, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany.,Interdisciplinary Transplant Center, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Julia C Schmid
- I. Department of Internal Medicine, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Maria Hoppe-Lotichius
- Department of General-, Abdominal- and Transplantation- Surgery, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Ana P Barreiros
- I. Department of Internal Medicine, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany.,Deutsche Stiftung Organtransplantation, Mainz, Germany
| | - Mimoun Azizi
- Department of Neurology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Tilman Emrich
- Department of Radiology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Christian Geber
- Department of Neurology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Arno Schad
- Institute of Pathology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Veronica Weyer
- Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Gerd Otto
- Department of General-, Abdominal- and Transplantation- Surgery, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Michael Heise
- Interdisciplinary Transplant Center, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany.,Department of General-, Abdominal- and Transplantation- Surgery, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jens Mittler
- Interdisciplinary Transplant Center, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany.,Department of General-, Abdominal- and Transplantation- Surgery, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Frank Birklein
- Department of Neurology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Hauke Lang
- Interdisciplinary Transplant Center, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany.,Department of General-, Abdominal- and Transplantation- Surgery, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Peter R Galle
- I. Department of Internal Medicine, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany.,Interdisciplinary Transplant Center, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Tim Zimmermann
- I. Department of Internal Medicine, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany.,Interdisciplinary Transplant Center, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
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17
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Saelices L, Chung K, Lee JH, Cohn W, Whitelegge JP, Benson MD, Eisenberg DS. Amyloid seeding of transthyretin by ex vivo cardiac fibrils and its inhibition. Proc Natl Acad Sci U S A 2018; 115:E6741-E6750. [PMID: 29954863 PMCID: PMC6055172 DOI: 10.1073/pnas.1805131115] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Each of the 30 human amyloid diseases is associated with the aggregation of a particular precursor protein into amyloid fibrils. In transthyretin amyloidosis (ATTR), mutant or wild-type forms of the serum carrier protein transthyretin (TTR), synthesized and secreted by the liver, convert to amyloid fibrils deposited in the heart and other organs. The current standard of care for hereditary ATTR is liver transplantation, which replaces the mutant TTR gene with the wild-type gene. However, the procedure is often followed by cardiac deposition of wild-type TTR secreted by the new liver. Here we find that amyloid fibrils extracted from autopsied and explanted hearts of ATTR patients robustly seed wild-type TTR into amyloid fibrils in vitro. Cardiac-derived ATTR seeds can accelerate fibril formation of wild-type and monomeric TTR at acidic pH and under physiological conditions, respectively. We show that this seeding is inhibited by peptides designed to complement structures of TTR fibrils. These inhibitors cap fibril growth, suggesting an approach for halting progression of ATTR.
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Affiliation(s)
- Lorena Saelices
- Howard Hughes Medical Institute, University of California, Los Angeles, CA 90095
- UCLA-DOE, University of California, Los Angeles, CA 90095
- Department of Biological Chemistry, University of California, Los Angeles, CA 90095
- Molecular Biology Institute, University of California, Los Angeles, CA 90095
| | - Kevin Chung
- Howard Hughes Medical Institute, University of California, Los Angeles, CA 90095
- UCLA-DOE, University of California, Los Angeles, CA 90095
- Department of Biological Chemistry, University of California, Los Angeles, CA 90095
- Molecular Biology Institute, University of California, Los Angeles, CA 90095
| | - Ji H Lee
- Howard Hughes Medical Institute, University of California, Los Angeles, CA 90095
- UCLA-DOE, University of California, Los Angeles, CA 90095
- Department of Biological Chemistry, University of California, Los Angeles, CA 90095
- Molecular Biology Institute, University of California, Los Angeles, CA 90095
| | - Whitaker Cohn
- Neuropsychiatric Institute (NPI)-Semel Institute, University of California, Los Angeles, CA 90024
| | - Julian P Whitelegge
- Neuropsychiatric Institute (NPI)-Semel Institute, University of California, Los Angeles, CA 90024
| | - Merrill D Benson
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202
| | - David S Eisenberg
- Howard Hughes Medical Institute, University of California, Los Angeles, CA 90095;
- UCLA-DOE, University of California, Los Angeles, CA 90095
- Department of Biological Chemistry, University of California, Los Angeles, CA 90095
- Molecular Biology Institute, University of California, Los Angeles, CA 90095
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18
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Horvat N, Marcelino ASZ, Horvat JV, Yamanari TR, Batista Araújo-Filho JDA, Panizza P, Seda-Neto J, Antunes da Fonseca E, Carnevale FC, Mendes de Oliveira Cerri L, Chapchap P, Cerri GG. Pediatric Liver Transplant: Techniques and Complications. Radiographics 2018; 37:1612-1631. [PMID: 29019744 DOI: 10.1148/rg.2017170022] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Liver transplant is considered to be the last-resort treatment approach for pediatric patients with end-stage liver disease. Despite the remarkable advance in survival rates, liver transplant remains an intricate surgery with significant morbidity and mortality. Early diagnosis of complications is crucial for patient survival but is challenging given the lack of specificity in clinical presentation. Knowledge of the liver and vascular anatomy of the donor and the recipient or recipients before surgery is also important to avoid complications. In this framework, radiologists play a pivotal role on the multidisciplinary team in both pre- and postoperative scenarios by providing a road map to guide the surgery and by assisting in diagnosis of complications. The most common complications after liver transplant are (a) vascular, including the hepatic artery, portal vein, hepatic veins, and inferior vena cava; (b) biliary; (c) parenchymal; (d) perihepatic; and (e) neoplastic. The authors review surgical techniques, the role of each imaging modality, normal posttransplant imaging features, types of complications after liver transplant, and information required in the radiology report that is critical to patient care. They present an algorithm for an imaging approach for pediatric patients after liver transplant and describe key points that should be included in radiologic reports in the pre- and postoperative settings. Online supplemental material is available for this article. ©RSNA, 2017.
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Affiliation(s)
- Natally Horvat
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Antonio Sergio Zafred Marcelino
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Joao Vicente Horvat
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Tássia Regina Yamanari
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Jose de Arimateia Batista Araújo-Filho
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Pedro Panizza
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Joao Seda-Neto
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Eduardo Antunes da Fonseca
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Francisco Cesar Carnevale
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Luciana Mendes de Oliveira Cerri
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Paulo Chapchap
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Giovanni Guido Cerri
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
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Sekijima Y, Ueda M, Koike H, Misawa S, Ishii T, Ando Y. Diagnosis and management of transthyretin familial amyloid polyneuropathy in Japan: red-flag symptom clusters and treatment algorithm. Orphanet J Rare Dis 2018; 13:6. [PMID: 29343286 PMCID: PMC5773042 DOI: 10.1186/s13023-017-0726-x] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 11/23/2017] [Indexed: 01/05/2023] Open
Abstract
Hereditary ATTR (ATTRm) amyloidosis (also called transthyretin-type familial amyloid polyneuropathy [ATTR-FAP]) is an autosomal-dominant, adult-onset, rare systemic disorder predominantly characterized by irreversible, progressive, and persistent peripheral nerve damage. TTR gene mutations (e.g. replacement of valine with methionine at position 30 [Val30Met (p.Val50Met)]) lead to destabilization and dissociation of TTR tetramers into variant TTR monomers, which form amyloid fibrils that deposit in peripheral nerves and various organs, giving rise to peripheral and autonomic neuropathy and several non-disease specific symptoms. Phenotypic and genetic variability and non–disease-specific symptoms often delay diagnosis and lead to misdiagnosis. Red-flag symptom clusters simplify diagnosis globally. However, in Japan, types of TTR variants, age of onset, penetrance, and clinical symptoms of Val30Met are more varied than in other countries. Hence, development of a Japan-specific red-flag symptom cluster is warranted. Presence of progressive peripheral sensory-motor polyneuropathy and ≥1 red-flag sign/symptom (e.g. family history, autonomic dysfunction, cardiac involvement, carpal tunnel syndrome, gastrointestinal disturbances, unexplained weight loss, and immunotherapy resistance) suggests ATTR-FAP. Outside of Japan, pharmacotherapeutic options are first-line therapy. However, because of positive outcomes (better life expectancy and higher survival rates) with living donor transplant in Japan, liver transplantation remains first-line treatment, necessitating a Japan-specific treatment algorithm. Herein, we present a consolidated review of the ATTR-FAP Val30Met landscape in Japan and summarize findings from a medical advisory board meeting held in Tokyo on 18th August 2016, at which a Japan-specific ATTR-FAP red-flag symptom cluster and treatment algorithm was developed. Beside liver transplantation, a TTR-stabilizing agent (e.g. tafamidis) is a treatment option. Early diagnosis and timely treatment using the Japan-specific red-flag symptom cluster and treatment algorithm might help guide clinicians regarding apt and judicious use of available treatment modalities.
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Affiliation(s)
- Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto-shi, Kumamoto, 860-8556, Japan
| | - Haruki Koike
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sonoko Misawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | | | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto-shi, Kumamoto, 860-8556, Japan.
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Matsushima M, Yabe I, Tsuda M, Sakakibara M, Shimamura T, Sasaki H. Amyloid Polyneuropathy and Myocardial Amyloidosis 10 Years after Domino Liver Transplantation from a Patient with a Transthyretin Ser50Arg Mutation. Intern Med 2017; 56:3231-3235. [PMID: 28943540 PMCID: PMC5742399 DOI: 10.2169/internalmedicine.8434-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 54-year-old man with polycystic liver disease received a domino liver transplantation (DLT) from a patient of hereditary ATTR amyloidosis with the transthyretin Ser50Arg mutation. Ten years after transplantation, he felt a slight numbness in his toes, and cardiac amyloidosis was simultaneously suspected upon a heart function evaluation. Biopsy specimens from the myocardium revealed transthyretin amyloidosis with the Ser50Arg mutation. Oral tafamidis therapy has inhibited the progression of neurological and cardiovascular symptoms this far. We herein report this first case of amyloid polyneuropathy and myocardial amyloidosis after DLT from hereditary ATTR amyloidosis with a transthyretin Ser50Arg mutation and discuss similar cases of other mutations.
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Affiliation(s)
- Masaaki Matsushima
- Department of Neurology, Hokkaido University Graduate School of Medicine, Japan
| | - Ichiro Yabe
- Department of Neurology, Hokkaido University Graduate School of Medicine, Japan
| | - Masaya Tsuda
- Department of Cardiology, Hokkaido University Graduate School of Medicine, Japan
| | - Mamoru Sakakibara
- Department of Cardiology, Hokkaido University Graduate School of Medicine, Japan
| | | | - Hidenao Sasaki
- Department of Neurology, Hokkaido University Graduate School of Medicine, Japan
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Acquired transthyretin amyloidosis after domino liver transplant: Phenotypic correlation, implication of liver retransplantation. J Neurol Sci 2017; 379:192-197. [DOI: 10.1016/j.jns.2017.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/08/2017] [Accepted: 06/12/2017] [Indexed: 12/31/2022]
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Masuda T, Ueda M, Suenaga G, Misumi Y, Tasaki M, Izaki A, Yanagisawa Y, Inoue Y, Motokawa H, Matsumoto S, Mizukami M, Arimura A, Deguchi T, Nishio Y, Yamashita T, Inomata Y, Obayashi K, Ando Y. Early skin denervation in hereditary and iatrogenic transthyretin amyloid neuropathy. Neurology 2017; 88:2192-2197. [DOI: 10.1212/wnl.0000000000004016] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/16/2017] [Indexed: 11/15/2022] Open
Abstract
Objective:To elucidate early skin denervation in hereditary transthyretin (TTR) amyloidosis and iatrogenic TTR amyloidosis.Methods:We investigated intraepidermal nerve fiber density (IENFD) and clinical findings in 32 patients with hereditary TTR amyloidosis, 11 asymptomatic mutation carriers, 6 patients with iatrogenic TTR amyloidosis, and 23 healthy volunteers.Results:IENFD values were reduced in patients with the V30M mutation (1.9 ± 2.1 per 1 mm), patients with non-V30M mutations (5.8 ± 3.2 per 1 mm), and patients with iatrogenic TTR amyloidosis (3.5 ± 1.8 per 1 mm) compared with healthy volunteers (11.8 ± 3.2 per 1 mm) (p < 0.01). Skin denervation also occurred, even in presymptomatic V30M mutation carriers (5.0 ± 2.2 per 1 mm). The IENFD was correlated with disease duration (ρ = −0.533, p = 0.002) and various peripheral neuropathy parameters such as sensory impairment in the Kumamoto clinical score (ρ = −0.575, p = 0.001), heat-pain detection threshold (ρ = −0.704, p < 0.001), and sural sensory nerve action potential (ρ = 0.481, p = 0.005). TTR amyloid deposits frequently occurred in connective tissues and vessels of the dermal reticular layer in patients with hereditary TTR amyloidosis and those with iatrogenic TTR amyloidosis.Conclusions:Patients with hereditary TTR amyloidosis and those with iatrogenic TTR amyloidosis may show early skin denervation even in the presymptomatic stage. IENFD may thus be useful for early diagnosis and may serve as a biomarker in clinical trials for hereditary and iatrogenic TTR amyloidosis.
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Tsuda Y, Misumi Y, Ueda M, Tasaki M, Huang G, Masuda T, Suenaga G, Kinoshita Y, Obayashi K, Yamashita T, Ando Y. Iatrogenic systemic transthyretin amyloid deposits in a case with domino liver transplantation: an autopsy case study. Amyloid 2017; 24:125. [PMID: 28434358 DOI: 10.1080/13506129.2017.1287071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Yukimoto Tsuda
- a Department of Neurology , Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan and
| | - Yohei Misumi
- a Department of Neurology , Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan and
| | - Mitsuharu Ueda
- a Department of Neurology , Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan and
| | - Masayoshi Tasaki
- a Department of Neurology , Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan and.,b Department of Morphological and Physiological Sciences , Graduate School of Health Sciences, Kumamoto University , Kumamoto , Japan
| | - Guannan Huang
- a Department of Neurology , Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan and
| | - Teruaki Masuda
- a Department of Neurology , Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan and
| | - Genki Suenaga
- a Department of Neurology , Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan and
| | - Yumiko Kinoshita
- a Department of Neurology , Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan and
| | - Konen Obayashi
- b Department of Morphological and Physiological Sciences , Graduate School of Health Sciences, Kumamoto University , Kumamoto , Japan
| | - Taro Yamashita
- a Department of Neurology , Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan and
| | - Yukio Ando
- a Department of Neurology , Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan and
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Misumi Y, Oshima T, Ueda M, Yamashita T, Tasaki M, Masuda T, Obayashi K, Ando Y. Occurrence factors and clinical picture of iatrogenic transthyretin amyloidosis after domino liver transplantation. Amyloid 2017; 24:123-124. [PMID: 28434312 DOI: 10.1080/13506129.2017.1278690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Yohei Misumi
- a Department of Neurology , Graduate School of Medical Sciences , Kumamoto , Japan and
| | - Toshinori Oshima
- a Department of Neurology , Graduate School of Medical Sciences , Kumamoto , Japan and
| | - Mitsuharu Ueda
- a Department of Neurology , Graduate School of Medical Sciences , Kumamoto , Japan and
| | - Taro Yamashita
- a Department of Neurology , Graduate School of Medical Sciences , Kumamoto , Japan and
| | - Masayoshi Tasaki
- a Department of Neurology , Graduate School of Medical Sciences , Kumamoto , Japan and.,b Department of Morphological and Physiological Sciences , Graduate School of Health Sciences, Kumamoto University , Kumamoto , Japan
| | - Teruaki Masuda
- a Department of Neurology , Graduate School of Medical Sciences , Kumamoto , Japan and
| | - Konen Obayashi
- b Department of Morphological and Physiological Sciences , Graduate School of Health Sciences, Kumamoto University , Kumamoto , Japan
| | - Yukio Ando
- a Department of Neurology , Graduate School of Medical Sciences , Kumamoto , Japan and
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Mnatsakanova D, Živković SA. Iatrogenic amyloid polyneuropathy after domino liver transplantation. World J Hepatol 2017; 9:126-130. [PMID: 28217248 PMCID: PMC5295145 DOI: 10.4254/wjh.v9.i3.126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/04/2016] [Accepted: 12/09/2016] [Indexed: 02/06/2023] Open
Abstract
Liver transplantation has been used in treatment of transthyretin amyloidosis, and some patients undergo domino liver transplantation (DLT) with explanted liver being transplanted to another patient with liver failure as the liver is otherwise usually functionally normal. Until end of 2015, there were 1154 DLT performed worldwide. DLT for transthyretin amyloidosis is associated with the risk of developing de novo systemic amyloidosis and amyloid neuropathy, and the risk may be greater with some non-Val30Met mutations. De novo amyloid neuropathy has been described in up to 23% of transplant recipients. Neuropathy may be preceded by asymptomatic amyloid deposition in various tissues and symptoms of neuropathy started after a median of 7 years following DLT (5.7 ± 3.2 years; range 2 mo to 10 years). Typical initial symptoms include neuropathic pain and sensory loss, while dysautonomia usually starts later. Progression of neuropathy may necessitate liver re-transplantation, and subsequent improvement of neuropathy has been reported in some patients. Explant allograft recipients need close monitoring for signs of systemic amyloidosis, neuropathy and dysautonomia as progressive symptoms may require re-transplantation.
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Kerschen P, Planté-Bordeneuve V. Current and Future Treatment Approaches in Transthyretin Familial Amyloid Polyneuropathy. Curr Treat Options Neurol 2016; 18:53. [PMID: 27873215 DOI: 10.1007/s11940-016-0436-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OPINION STATEMENT Treatment of transthyretin familial amyloid polyneuropathy (TTR FAP) must be tailored to disease stage. Patients with early stage disease (i.e., without major impairment in walking ability), especially younger patients, should be referred as soon as possible for liver transplantation (LT) in the absence of major comorbid conditions. LT remains the most effective treatment option to date and should be offered to these patients as early as possible. Bridging therapy with an oral TTR stabilizer (tafamidis or diflunisal, according to local access to these treatments) should be started as soon as the diagnosis of TTR FAP is established. Early stage patients who do not wish to or have contraindications to LT should be treated with an oral TTR stabilizer or get access to the newly developed therapeutic options (IONIS TTR-Rx, patisiran, doxycycline/TUDCA). Late stage patients (presenting with significant walking impairment) are usually older and notoriously difficult to treat. They should be offered an oral TTR stabilizer but are not candidates for LT due to a significant rate of perioperative complications and increased risk of progressive neurological and especially cardiac disease despite LT. Access to the different therapies in development should also be considered depending on respective inclusion and exclusion criteria. The abovementioned treatment options were mostly validated in Val30Met mutation patients, but should also be offered to non-Val30Met patients, although mortality rates after LT are higher in these patients. Treatment decisions should be made on an individual basis. Screening for heart, eye, and renal involvement is mandatory for every patient at disease diagnosis and regularly thereafter, even in transplanted patients. Symptomatic treatment should be offered as needed, as well as genetic counseling to at-risk family members. Asymptomatic mutation carriers should benefit from regular screening for early symptoms of disease. Current therapeutic management of TTR FAP will hopefully be changed in the near future with data from the ongoing phase 2/3 studies testing the TTR gene silencing agents. In the longer term, it is likely that combined therapeutic approaches will be necessary to reverse the disease process.
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Affiliation(s)
- Philippe Kerschen
- Service de Neurologie, Centre Hospitalier de Luxembourg, 4 rue Barblé, L-1210, Luxembourg, Luxembourg
| | - Violaine Planté-Bordeneuve
- Service de Neurologie, CHU Henri Mondor, 51 avenue de Lattre de Tassigny, 94000, Créteil, France. .,Groupe de Recherche Clinique Amylose, Université Paris-Est-Créteil, 94000, Créteil, France.
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