Maximum sharing of cadaver liver grafts composite split and domino liver transplants.

Abstract

Shortage of cadaver donors is a well-known problem for the long lists of patients awaiting organ transplants. The waiting lists for liver transplantion in the four units of Portugal are overcrowded. Besides the usual hepatic pathologies in Europe and America, Portugal has some hundreds of patients with familial amyloidotic polineuropathy (FAP) for whom the sole hope of stopping the progression of the disease is liver transplantation. Except for the production of an abnormal protein that is responsible for the amyloid deposition in the nervous tissues and in several organs (kidney, heart, etc.), their livers are anatomically and functionally normal. The clinical picture of FAP takes 20 to 30 years to appear and another 10 to 14 years to become fatal. This was why, in 1995, we started offering the native livers retrieved from FAP patients undergoing transplantation to other patients with malignancies, with no chance of being accepted in any one of our four units for cadaver graft transplantation. This sequential or domino liver transplantation has been applied to 20 patients in our unit without any complication attributable to the technical peculiarities of this procedure.