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Review
. 2021 Dec;25(8):e14114.
doi: 10.1111/petr.14114. Epub 2021 Aug 27.

Domino transplantation for pediatric liver recipients: Obstacles, challenges, and successes

Vikram K Raghu  1 , Peter D Carr-Boyd  2 , James E Squires  1 , Jerry Vockley  3 , Nicolas Goldaracena  4 , George V Mazariegos  2
Affiliations
Review

Domino transplantation for pediatric liver recipients: Obstacles, challenges, and successes

Vikram K Raghu et al. Pediatr Transplant. 2021 Dec.

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.

Keywords: familial amyloidotic polyneuropathy; living donor; maple syrup urine disease; metabolic liver disease.

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Figures

FIGURE 1
FIGURE 1
Surgical technique of whole liver domino donor operation. (A) Suprahepatic caval dissection performed to ensure adequate cuff length with ligation of the phrenic veins. (B) Lateral view of infrahepatic dissection with adequate length above left renal vein. (C) Hilar dissection with particular focus on ensuring adequate length of the hepatic artery and portal vein for both domino donor and recipient. Common bile duct, portal vein, and hepatic and gastroduodenal arteries shown left to right
See this image and copyright information in PMC

References

    1. Starzl TE, Groth CG, Brettschneider L, et al. Orthotopic homotransplantation of the human liver. Ann Surg. 1968;168(3):392–415. - PMC - PubMed
    1. Starzl TE, Groth CG, Brettschneider L, et al. Extended survival in 3 cases of orthotopic homotransplantation of the human liver. Surgery. 1968;63(4):549–563. - PMC - PubMed
    1. Klepetko W, Wollenek G, Laczkovics A, Laufer G, Wolner E. Domino transplantation of heart-lung and heart: an approach to overcome the scarcity of donor organs. J Heart Lung Transplant. 1991;10(1 Pt 1):129–131. - PubMed
    1. Yacoub MH, Banner NR, Khaghani A, et al. Heart-lung transplantation for cystic fibrosis and subsequent domino heart transplantation. J Heart Transplant. 1990;9(5):459–466; discussion 466–457. - PubMed
    1. Furtado A, Tome L, Oliveira FJ, Furtado E, Viana J, Perdigoto R. Sequential liver transplantation. Transplant Proc. 1997;29(1–2):467–468. - PubMed