Combined Heart-Liver and Domino Liver Transplantation in Familial Amyloidosis

Abstract

Background Combined heart-liver transplantation (CHLT) is the only curative option for patients with concomitant pathology affecting the heart and liver. In some cases, the native livers of familial amyloidosis (FA) patients may be suitable for domino transplantation into other recipients. Methods Retrospective analysis (2013 to 2019) of all CHLT at our center was performed. Continuous data were presented as mean with standard deviation and discrete variables as percentages. Results Familial amyloidosis was the indication for CHLT in 5 out of 6 patients. The mean recipient age was 55 ± 5.62 years. Two patients were bridged with total artificial heart. The mean model for end-stage liver disease score at transplant was 17.17 ± 3.7. Two explanted livers were used for transplantation in a domino fashion. The median intensive care and hospital stays were 5.5 and 19 days, respectively. Complications included renal failure (1), groin abscess (1), pulmonary embolism (1), and cardiac rejection (1). Patient and graft survival for both organs was 100% at a median follow-up of 59 (range 20-76) months. Discussion Combined heart-liver transplantation for FA achieves excellent outcomes. The possible use of livers explanted from patients with FA for domino liver transplantation can contribute to the liver donor pool.

Clinical outcomes after transplantation of domino grafts or standard deceased donor livers: a systematic review and meta‐analysis

“…35 Some studies have explored combined domino heart-liver transplantation for FAP with good outcomes. 36,37 However, give the small number of reports, we were not able to analyze and draw robust conclusions in the current study.…”

“…The common right iliac vein was then anastomosed to the common stump of the domino graft middle and left hepatic vein; ultimately, the cadaveric IVC cuff was connected to the recipients middle and left hepatic veins 35 . Some studies have explored combined domino heart–liver transplantation for FAP with good outcomes 36,37 . However, give the small number of reports, we were not able to analyze and draw robust conclusions in the current study.…”

Dual organ transplantation: when heart alone is not enough

“…These explanted livers can then be transplanted into other end-stage liver patients with good results. While such domino liver transplantation was first described in 1995, a recent study reported the experience with domino liver transplant in CHLT [35,36]. This single-center experience appears promising with excellent survival rates.…”

Heart transplantation in cardiac amyloidosis

“…Concerning the ATTR CA patients, the first proposed option was liver transplant (LT); subsequently, HTx has been combined with LT to avoid the potential development of the cardiomyopathy after LT alone [22][23] . Conversely, isolated HTx has been done in those patients without extracardiac deposits and end-stage HF, showing very encouraging results [24] .…”