Pediatric Full and In-situ Split Domino Living Donor Liver Transplants Experience

Domino liver transplantation (DLT) is a method in which an explanted liver from a patient with metabolic disease is transplanted to another recipient. In cases where the liver is split and used for two recipients, the technique is termed domino split liver transplantation.

This study presents our experience with three pediatric DLT cases, in which liver grafts from two donor-recipient patients with maple syrup urine disease (MSUD) were transplanted to separate recipients. First donor recipient's liver was splitted in situ, while the other was transplanted as a full-sized graft. Demographics, surgical techniques, biliary reconstruction methods, and posttransplant outcomes were analyzed.

All recipients were discharged uneventfully following transplantation. No vascular or biliary complications were observed, and de novo MSUD did not develop in any recipient. This confirms that MSUD livers are safe for DLT, particularly in pediatric cases.

DLT using MSUD donor livers is a viable option for expanding the organ pool for pediatric transplantation. Advancements in surgical techniques and perioperative care contribute to improved patient outcomes, making DLT a valuable strategy in liver transplantation programs.