Liver Retransplantation in Patients With Acquired Familial Amyloid Polyneuropathy: A Portuguese Center Experience

Vieira, Henrique Duarte; Rodrigues, Cidália; Pereira, Lilian Elgalise Techio; Jesús, Jorge de; Bento, Carlos; Seco, Carlos; Pinto, Fausto J.; Eufrásio, Ana; Calretas, S.; Silva, Nuno; Ferrão, José; Tomé, Luís; Barros, A.; Diogo, D.; Furtado, Emanuel

doi:10.1016/j.transproceed.2015.04.003

Cited by 11 publications

(4 citation statements)

References 14 publications

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“…In some recipients, retransplantation has been reported to stabilize or improve neuropathy, highlighting the importance of considering early retransplantation. Despite liver retransplantation typically carrying a worse prognosis and more significant morbidity than the initial transplantation, survival after liver retransplantation in DLT recipients seems to be greater than in other subgroups of liver retransplant recipients [ 13 ]. This approach necessitates careful evaluation and personalized decision-making for each patient to optimize outcomes.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Amyloid Polyneuropathy Following Domino Liver Transplantation: A Case Report

Junqueira,

Mestre

2024

Cureus

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Familial amyloidotic polyneuropathy (FAP) is an autosomal dominant hereditary disorder. In Portugal, it is mainly linked to transthyretin (TTR) mutation, and patients present with length-dependent sensory-motor polyneuropathy, often accompanied by autonomic dysfunction. Treatment options for FAP include liver transplant, and due to the lack of organs, FAP livers began being implanted in patients with severe liver disease in a process known as domino liver transplantation (DLT). We report a case of a 68-year-old Portuguese man, with post-hepatitis C-related cirrhosis liver transplantation, who presented to his family doctor with decreased sensitivity in both feet and weight loss, which were initially attributed to diabetic neuropathy and an adjustment in diabetic medication, respectively. Symptoms evolved to changes in both feet's thermal and painful sensitivity, reduced sensitivity in both hands, diarrhea, and progressive weight loss. At this time, the patient's disclosure of receiving a DLT prompted the correct diagnosis of iatrogenic amyloid polyneuropathy. This case underscores the challenges in diagnosing and managing iatrogenic amyloid polyneuropathy following DLT, highlighting the importance of prompt identification of DLT recipients, active vigilance of these patients via structured monitoring, and increased healthcare providers' awareness of this practice so that early signs of the disease may be recognized.

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Section: Discussionmentioning

confidence: 99%

Iatrogenic Amyloid Polyneuropathy Following Domino Liver Transplantation: A Case Report

Junqueira,

Mestre

2024

Cureus

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“…In the series presented by Misumi et al, the prevalence of symptomatic AAN among DLT recipients was 23% [ 20 ], whereas in our center, Lladó et al reported that all patients had developed AAN at 90 months of follow-up [ 19 ]. Although liver re-transplantation is a viable treatment option, most patients are ineligible due to age or comorbidities [ 24 , 28 , 29 ], necessitating that we consider other treatment options. The generic nonsteroidal anti-inflammatory drug diflunisal is a nonspecific tetramer stabilizer of TTR that may prevent misfolding monomers and dimers from forming amyloid deposits in the heart and peripheral nerves [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Treatment With Diflunisal in Domino Liver Transplant Recipients With Acquired Amyloid Neuropathy

Nedkova-Hristova¹,

Baliellas²,

González‐Costello³

et al. 2022

Transpl Int

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“…In countries where tafamidis is available, liver transplantation is often considered as a second-line option for patients who progressed on tafamidis or did not tolerate the treatment. Liver-retransplantation typically carries worse prognosis and more significant morbidity than the initial transplantation, but the survival after liver retransplantation in DLT recipients seems to be greater than in other subgroups of liver retransplant recipients[ 36 ]. Despite a single report of benefits with deflunisal[ 37 ], potential benefits of treatment with tetramer stabilizers in DLT recipients remain uncertain.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic amyloid polyneuropathy after domino liver transplantation

Mnatsakanova

Živković

2017

WJH

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Liver transplantation has been used in treatment of transthyretin amyloidosis, and some patients undergo domino liver transplantation (DLT) with explanted liver being transplanted to another patient with liver failure as the liver is otherwise usually functionally normal. Until end of 2015, there were 1154 DLT performed worldwide. DLT for transthyretin amyloidosis is associated with the risk of developing de novo systemic amyloidosis and amyloid neuropathy, and the risk may be greater with some non-Val30Met mutations. De novo amyloid neuropathy has been described in up to 23% of transplant recipients. Neuropathy may be preceded by asymptomatic amyloid deposition in various tissues and symptoms of neuropathy started after a median of 7 years following DLT (5.7 ± 3.2 years; range 2 mo to 10 years). Typical initial symptoms include neuropathic pain and sensory loss, while dysautonomia usually starts later. Progression of neuropathy may necessitate liver re-transplantation, and subsequent improvement of neuropathy has been reported in some patients. Explant allograft recipients need close monitoring for signs of systemic amyloidosis, neuropathy and dysautonomia as progressive symptoms may require re-transplantation.

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Liver Retransplantation in Patients With Acquired Familial Amyloid Polyneuropathy: A Portuguese Center Experience

Cited by 11 publications

References 14 publications

Iatrogenic Amyloid Polyneuropathy Following Domino Liver Transplantation: A Case Report

Iatrogenic Amyloid Polyneuropathy Following Domino Liver Transplantation: A Case Report

Treatment With Diflunisal in Domino Liver Transplant Recipients With Acquired Amyloid Neuropathy

Iatrogenic amyloid polyneuropathy after domino liver transplantation

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