World’s first ‘domino’ liver transplant treats two patients

For the first time, surgeons successfully transplanted a liver into a man with a rare genetic disorder and transplanted that man’s liver into a second patient with primary sclerosing cholangitis.

Two transplant teams performed simultaneous surgeries at the Center for Hepatobiliary Disease and Abdominal Transplantation at UC San Diego Health System.

Patient No. 1 had the rare genetic disorder methylmalonic acidemia, a metabolic disease that causes a toxic buildup of amino acids in the body, according to a hospital press release. He received a liver from a donor. His liver was then transplanted, or “dominoed,” into patient No. 2, who had primary sclerosing cholangitis, a chronic liver disease caused by scarring of the bile ducts. Even though patient No. 2 received a liver with a genetic disorder, it will not affect his health, the surgeons said, because his body will clear the amino acids and be symptom-free.

“This extraordinary procedure allowed us to use one donated liver to save two lives,” Alan Hemming, MD, professor and co-director of the center, said in the release. “This procedure is technically more difficult but allows us to expand the number of patients who can benefit from this lifesaving surgery.”

“Liver transplantation was the only solution for both patients,” Robert Gish, MD, chief of hepatology and the center’s co-director, said. “The challenge is that donated livers are in short supply, even for patients who desperately need transplantation.”

According to the U.S. Department of Health and Human Services, more than 16,000 patients were awaiting a liver transplant in the United States as of September 2011.