Considerations for Use of Domino Cross-Auxiliary Liver Transplantation in Metabolic Liver Diseases: A review of Case Studies

Background: Domino cross-auxiliary liver transplantation represents an innovative procedure for the treatment of selective non-cirrhotic metabolic liver diseases. Methods: The treatment strategies and experiences in domino cross-auxiliary liver transplantations, including the world's first case in 2013, are reviewed. Results: The 6 patients with non-cirrhotic metabolic liver diseases receiving domino cross-auxiliary liver transplantation included: FAP (Case 1), OTCD (Cases 3,5,6) and Wilson's disease (Cases 2,4). Five patients achieved a favorable postoperative survival outcome and quality of life, while Case 2 died of multiple organ failure at 3 months post liver transplant (LT). Case 1 experienced an imbalance in portal vein blood perfusion between the two domino livers at 6 months after LT, but improved after interventional radiology treatment. Cases 3 and 4 showed domino grafts associated with hypercholesterolemia after LT, but total cholesterol levels decreased to normal ranges after dietary adjustment. Case 5 showed an effortless recovery after surgery with no complications during the follow-up period. Case 6 experienced an occult domino liver graft rejection, which resulted in graft dysfunction and eventual recurrence of the primary metabolic liver disease (OTCD). A liver re-transplantation may be required for this patient. Conclusions: Domino Cross-auxiliary liver transplantation is an innovative and effective treatment for metabolic liver diseases in the patients who are strictly selected as based upon pathophysiological and genetic criteria. Special attention to rejection monitoring and imbalance regeneration are required with this procedure. Co-first author: Lin Wei, Liver Transplantation Section, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University. Corresponding author: Zhi-Jun Zhu, Liver Transplantation Section, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Yong'an Road 95, Xicheng District, Beijing 100050, China. E-mail: zhu-zhijun@outlook.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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