Iatrogenic amyloid polyneuropathy after domino liver transplantation

作     者：Diana Mnatsakanova Sasa A Zivkovic 

作者机构：Department of Neuro-logyUniversity of Pittsburgh Medical CenterPittsburghPA 15213United States 

出 版 物：《World Journal of Hepatology》 (世界肝病学杂志（英文版）（电子版）)

年 卷 期：2017年第9卷第3期

页      面：126-130页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：Transthyretin Familial amyloid neuropathy Domino liver transplantation Systemic amyloidosis Acquired amyloid neuropathy 

摘      要：Liver transplantation has been used in treatment of transthyretin amyloidosis, and some patients undergo domino liver transplantation(DLT) with explanted liverbeing transplanted to another patient with liver failure as the liver is otherwise usually functionally normal. Until end of 2015, there were 1154 DLT performed worldwide. DLT for transthyretin amyloidosis is associated with the risk of developing de novo systemic amyloidosis and amyloid neuropathy, and the risk may be greater with some non-Val30 Met mutations. De novo amyloid neuropathy has been described in up to 23% of transplant recipients. Neuropathy may be preceded by asymptomatic amyloid deposition in various tissues and symptoms of neuropathy started after a median of 7 years following DLT(5.7 ± 3.2 years; range 2 mo to 10 years). Typical initial symptoms include neuropathic pain and sensory loss, while dysautonomia usually starts later. Progression of neuropathy may necessitate liver re-transplantation, and subsequent improvement of neuropathy has been reported in some patients. Explant allograft recipients need close monitoring for signs of systemic amyloidosis, neuropathy and dysautonomia as progressive symptoms may require re-transplantation.