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• W2316483734 abstract "Introduction: A standardized follow up after domino liver transplantation (DLT) is lacking although de novo amyloidosis has been reported. Therefore, we implemented a special follow-up. The results and experiences of 12 years are reported herein. Patients and methods: 20 patients underwent DLT since 09/98. The longest follow-up was nearly 12 years (median 68 months, range 4 -142 months). After DLT patients were enrolled in a special protocol, beginning 3 months after transplantation. In addition to physical examination and blood tests, 5-day electrocardiogram, 24-hour blood pressure measurement, echocardiography, cardiac MRI, cardiac electrophysiological examinations, rectoscopy and extensive neurological examination were performed. This workup was repeated 3 years and 5 years after DLT and thereafter annually. Results: 10/20 patients died after median 29 months (range 4 - 142 months), due to HCC recurrence (n=4), HCV recurrence (n=1), sepsis (n=1), pulmonary embolism (n=1), malnutrition (n=1), pneumonia (n=1) or cardiac arrest (n=1). Since the fatal cardiac complication occurred 3 years after transplantation, deposition of amyloid is unlikely. The follow-up of the surviving patients was 5-131 months. 1/10 deceased patients showed a definite onset of amyloidosis after DLT. After 4 years she developed isolated neurologic symptoms without any motor or autonomic signs, obviously caused by CNI. Immunosuppression was switched from CNI to a mTOR. A rectal biopsy at this time showed no amyloid. 3 years later neurological symptoms deteriorated with progressive sensory loss in the lower limbs. One year later amyloid deposition was detectable in the gastrointestinal wall, reflecting de novo FAP 9 years after LT. This patient died after 142 months (12 years) because of malnutrition. Conclusion: During our 12 years follow up period 1 patient of 20 domino transplanted patients developed de novo amyloidosis. After DLT the onset of symptoms is significantly earlier than in inherited patients. In the face of organ shortage, the use of domino grafts for elderly and well chosen patients, however, seems to be justified. Nevertheless, a close follow-up is deemed advisable in order to exclude a manifestation of the disease in the recipient of the domino graft and to learn more about the pathophysiology of amyloidosis." @default.
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• W2316483734 date "2012-11-01" @default.
• W2316483734 modified "2023-10-18" @default.
• W2316483734 title "Follow-Up of Patients after Domino Liver Transplantation" @default.
• W2316483734 doi "https://doi.org/10.1097/00007890-201211271-00798" @default.
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