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The transmission of systemic transthyretin amyloidosis through domino liver transplantation, using a donor liver graft from a patient with familial amyloid neuropathy (FAP), was first described in 2005.1 This complication had not been expected, given that the onset of neurologic symptoms in cases of inherited amyloidosis typically occurs in the age range of 25 to 40 years. Accelerated deposition of amyloid in these types of liver recipients may be facilitated by the presence of amyloid fibrils in the donor liver, which act as a template for amyloidogenesis. We present a case with an unusually short latency of symptomatic onset in which therapy with diflunisal may have helped stabilize neuropathy and nephropathy while the patient waited for another liver transplant.
Bourque PR, Shafi S, Jansen GH, McCurdy A, Warman Chardon J. Amyloid Neuropathy Following Domino Liver TransplantationResponse to Diflunisal. JAMA Neurol. 2016;73(4):477-478. doi:10.1001/jamaneurol.2015.4715