Yazaki M, Mitsuhashi S, Tokuda T, Kametani F, Takei YI, Koyama J, Kawamorita A, Kanno H, Ikeda SI. Progressive wild-type transthyretin deposition after liver transplantation preferentially occurs onto myocardium in FAP patients.
Am J Transplant 2007;
7:235-42. [PMID:
17061984 DOI:
10.1111/j.1600-6143.2006.01585.x]
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Abstract
To elucidate whether progressive wild-type transthyretin (TTR) deposition can actually occur after liver transplantation (LT), amyloid fibrils were investigated in two familial amyloid polyneuropathy patients with TTR Val30Leu variant, who died 1 year after LT. Amyloid fibrils were extracted from cardiac muscles, sciatic nerves and kidney, which were investigated by the immunoprecipitation-mass spectrometry method and liquid chromatography-ion trap mass spectrometry analysis. The ratio of wild-type to variant TTR in cardiac muscle was approximately 5:5 before LT, but greatly increased to about 9:1 after transplantation. The ratios in sciatic nerves and kidney obtained at autopsy were approximately 5:5. Wild-type TTR was undetectable in kidney amyloid obtained before LT. Our results indicate that paradoxical wild-type TTR deposition after LT can preferentially occur in myocardium, leading to fatal cardiac dysfunction, but it is quite likely that this phenomenon can also occur in other visceral organs.
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