Published online Jan 28, 2017. doi: 10.4254/wjh.v9.i3.126
Peer-review started: September 1, 2016
First decision: September 29, 2016
Revised: October 14, 2016
Accepted: December 7, 2016
Article in press: December 9, 2016
Published online: January 28, 2017
Core tip: Domino liver transplantation (DLT) has been used in treatment of transthyretin amyloidosis, with explanted liver being transplanted to another patient with liver failure as the liver is otherwise usually functionally normal. Domino liver explant recipients are at risk of developing de novo systemic amyloidosis and amyloid neuropathy has been described in up to 23% of transplant recipients after a median of 7 years following DLT. Typical initial symptoms include neuropathic pain and sensory loss, while dysautonomia usually starts later. Explant allograft recipients need close monitoring for signs of systemic amyloidosis, neuropathy and dysautonomia as progressive symptoms may require re-transplantation.