About The Domino Transplantation Registry - DLTR


Introduction:

General shortage of cadaveric organs has led to a search for alternative methods to expand the donor pool. In domino transplantation organs explanted during transplantation in one patient are transplanted into a second patient. Domino liver transplantation (DLT) was first performed in Portugal in 1995, when a removed FAP-liver was transplanted into another patient in need of a liver transplantation. The domino approach can be considered in several genetic or biochemical disorders that are nowadays treated by liver transplantation. The crucial aspect is that such livers ultimately cause severe systemic disease but do not affect other functions of the liver. The first and main indication thus far has been familial amyloid polyneuropathy.

In order to gather as much information as possible on the DLT procedure an international register, the Domino Liver Transplant Registry (DLTR), was created in 1999 as an extension of the already existing Familial Amyloidotic Polyneuropathy World Transplant Registry (FAPWTR).

The DLTR registers not only the use of livers removed from FAP patients and patients with Fibrinogen a-chain amyloidosis, but also records data on livers used for transplantation from patients with other metabolic disorders such as oxalosis, hypercholesterolemia, hemochromatosis and maple syrup urine disease . However, the livers from FAP donors make up the majority of those reported to the DLTR. By December 31, 2016, a total of 1187 domino transplantations on 1167 patients were registered. They were reported from 65 different hospitals in 21 countries.