Three liver transplants after a single cadaveric procurement: Split liver transplantation plus domino liver transplantation, an infrequent but valid alternative for maximizing transplant sharing and applicability - Report of the first Latin American case

Abstract

The development of liver surgery and the need toovercome the shortage of cadaveric grafts havestimulated the creativity of surgeons in describingdifferent options for using segmental liver grafts.Reduced size liver transplantation, ex vivo and insitu split liver transplantation, and living relateddonor liver transplantation are options that havespread since their original descriptions.1 In the settingof these accepted strategies, the option of performingsequential or domino liver transplantationwith livers from patients with familial amyloidoticpolyneuropathy (FAP) has become possible, andthese patients have started to be used worldwide aswhole living donors for patients who otherwisewould not benefit from the current allocation systemand cannot apply for a segmental adult living donorgraft. The success of some of the aforementionedtechniques can be currently followed via Web-basedregistries such as the Familial Amyloidotic PolyneuropathyWorld Transplant Registry, which includes62 centers in 21 countries performing orthotopicliver transplantation with FAP donors.2 The need tofoster maximal sharing has led to surgical innovationsfor further splitting FAP livers or performingsplit liver transplants for a pediatric recipient andan adult recipient with FAP followed by sequentialor domino liver transplantation; however, only asmall number of cases of this kind have beendescribed.3-5 Therefore, we report here our experiencewith the first case of split transplantation plusdomino transplantation in Latin America at 2 Argentinean institutions.