Domino split-liver transplantation from a living donor: case reports of in situ and ex situ splitting.

The liver from a patient with familial amyloid polyneuropathy (FAP) scheduled for living donor liver transplantation can be split and transplanted into 2 adult patients with end-stage liver disease. We have performed this procedure, called domino split transplantation, twice. The native liver was split in situ in 1 patient with FAP and ex situ in the other patient with FAP. The recipients of the livers from the patients with FAP and their living donors are doing well without serious complications. Of the 4 secondary recipients, 3 patients survived. Domino split-liver transplantation from a living donor thus appears to be a promising procedure for expansion of the donor pool.