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Domino hepatic transplantation using the liver from a patient with primary hyperoxaluria
V Donckier1, I El Nakadi, J Closset
1Medicosurgical Department of Gastroenterology, Hĵpital Erasme, Université Libre de Bruxelles, Brussels, Belgium. vdonckie@ulb.ac.be
Background:
We report a case of domino liver transplantation using the liver harvested from a patient who underwent a combined liver and kidney transplantation for primary hyperoxaluria (PH).
Method:
A cadaveric liver transplantation was performed in a 19-year-old man with PH. In a second step, the PH liver harvested from the first patient was transplanted in a 69-year-old man with hepatitis C-related cirrhosis, not a candidate for a classic liver graft owing to multifocal hepatocellular carcinoma.
Results:
At 8 months after transplantation, the domino recipient has normal hepatic function and no signs of tumoral recurrence, but he progressively developed hyperoxalemia, hyperoxaluria, and renal insufficiency.
Conclusion:
Regarding the favorable postoperative clinical evolution, domino liver transplantations using livers from PH patients may represent a new opportunity for marginal candidates for liver transplantation. However, the progressive renal insufficiency expected in such domino recipients should limit this procedure to selected cases.