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October 1997

'Domino' Liver Transplantation Combined With Multivisceral Transplantation

Author Affiliations

From the Department of Surgery, Division of Transplantation, and the Department of Medicine, Division of Gastroenterology (Drs Tzakis, Nery, and Raskin), the Department of Pathology, Division of Immunopathology (Ms Weppler and Drs Khan, Fragulidis, and Ruiz), and the Department of Medicine, Division of Hepatology (Dr Reddy), University of Miami, Miami, Fla.

Arch Surg. 1997;132(10):1145-1147. doi:10.1001/archsurg.1997.01430340099018

Transplantation of the liver contemporaneously with another organ from the same donor is thought to confer an immunologic advantage.1,2 The latter is particularly desirable in intestinal transplantation because of the propensity of the intestinal graft to early and late rejections and because in some cases it may facilitate the operation. In clinical practice, shortage of liver grafts constrains liver transplantation to cases in which there is coexisting end stage liver disease.

We describe a technique in which the liver is included in a multivisceral graft and the resected liver is used for another needy patient. To our knowledge, this is the first such report.


Recipient of the Multivisceral Graft (RMVG)  A 17-year-old white girl with neurogenic intestinal pseudo-obstruction was referred to us for total abdominal gut transplantation. The disease had been diagnosed at 12 years of age and included all intra-abdominal hollow organs. The patient was unable to

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