Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2017; 23(44): 7939-7944
Published online Nov 28, 2017. doi: 10.3748/wjg.v23.i44.7939
First case of cross-auxiliary double domino donor liver transplantation
Zhi-Jun Zhu, Lin Wei, Wei Qu, Li-Ying Sun, Ying Liu, Zhi-Gui Zeng, Liang Zhang, En-Hui He, Hai-Ming Zhang, Ji-Dong Jia, Zhong-Tao Zhang
Zhi-Jun Zhu, Lin Wei, Wei Qu, Li-Ying Sun, Ying Liu, Zhi-Gui Zeng, Liver Transplantation Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Zhi-Jun Zhu, Lin Wei, Wei Qu, Li-Ying Sun, Ying Liu, Zhi-Gui Zeng, Liang Zhang, En-Hui He, Hai-Ming Zhang, Ji-Dong Jia, Zhong-Tao Zhang, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Zhi-Jun Zhu, Li-Ying Sun, Beijing Key Laboratory of Tolerance Induction and Organ Protection in Transplantation, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Author contributions: Zhu ZJ planned and performed the operations; Wei L, Qu W and Zeng ZG participated in the operations; Wei L, Qu W, Sun LY and Liu Y performed the patient management after the operations; Qu W and Liu Y followed the patients after discharge; He EH monitored the blood flow by ultrasound; Zhang HM and Zhu ZJ wrote the case report; Jia JD and Zhang ZT contributed to the treatments and operations as expert consultants; all authors contributed to this article.
Supported by Capital Special Program for Health Research and Development, No. 2016-1-2021; National Key Technologies R&D Program, No. 2015BAI13B09; The Training Program of Academic Leaders in Beijing Health System, No. 2014-2-002; Beijing Municipal Administration of Hospitals Ascent Plan, No. DFL20150101.
Institutional review board statement: This work was approved by the Ethics Committee of Beijing Friendship Hospital.
Informed consent statement: Written consent for the operations and the voluntary disclosure of personal data was obtained.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Zhi-Jun Zhu, MD, Liver Transplantation Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China. zhu-zhijun@outlook.com
Telephone: +86-10-63138350 Fax: +86-10-63138350
Received: August 7, 2017
Peer-review started: August 8, 2017
First decision: September 6, 2017
Revised: September 22, 2017
Accepted: October 27, 2017
Article in press: October 27, 2017
Published online: November 28, 2017
Abstract

We report a case of double domino liver transplantation in a 32-year-old woman who was diagnosed with familial amyloid polyneuropathy (FAP) and liver dysfunction. A two-stage surgical plan was designed, and one domino graft was implanted during each stage. During the first stage, an auxiliary domino liver transplantation was conducted using a domino graft from a 4-year-old female child with Wilson’s disease. After removing the right lobe of the FAP patient’s liver, the graft was rotated 90 degrees counterclockwise and placed along the right side of the inferior vena cava (IVC). The orifices of the left, middle, and right hepatic veins were reconstructed using an iliac vein patch and then anastomosed to the right side of the IVC. Thirty days later, a second domino liver graft was implanted. The second domino graft was from a 3-year-old female child with an ornithine carbamyl enzyme defect, and it replaced the residual native liver (left lobe). To balance the function and blood flow between the two grafts, a percutaneous transcatheter selective portal vein embolization was performed, and “the left portal vein” of the first graft was blocked 9 mo after the second transplantation. The liver function indices, blood ammonia, and 24-h urinary copper levels were normal at the end of a 3-year follow-up. These two domino donor grafts from donors with different metabolic disorders restored normal liver function. Our experience demonstrated a new approach for resolving metabolic disorders with domino grafts and utilizing explanted livers from children.

Keywords: Domino liver transplantation, Familial amyloid polyneuropathy, Double graft, Wilson’s disease, Ornithine transcarbamylase deficiency, Case report

Core tip: We implanted two domino graft livers into a familial amyloid polyneuropathy patient. One domino graft liver was from a child with Wilson’s disease, and the other was from a child with ornithine carbamyl enzyme defect. The blood flows of the two grafts were balanced by a percutaneous transcatheter selective portal vein embolization. These two domino donor grafts from donors with different metabolic disorders restored normal liver function. Our experience demonstrated a new approach to resolving metabolic disorders with domino grafts and utilizing explanted livers from children.