AUGUST 2009

Emory Transplant Surgeons Perform Georgia's First Domino Liver Transplant

Leading two surgical teams working in adjoining operating rooms, Dr. Stuart Knechtle and Dr. Christopher Hughes performed Georgia's first domino liver transplant procedure at Emory University Hospital on July 10, 2009. An extremely rare surgery requiring enormous skill to perform, domino procedures have been done less than 100 times in the United States since 1996, and involve the transplantation of a viable liver from a deceased donor into the first recipient, followed by transplantation of the first recipient's organ into a second recipient.

In this case, a deceased donor's liver was transplanted into Jean Handler, 24, who has suffered since birth from maple syrup urine disease (MSUD), a rare genetic disease caused by the absence of a particular enzyme in the body. While not exclusively affecting the liver, severe MSUD can progress to causing brain damage and/or slow or retarded mental development. The recipient of Ms. Handler's own liver was Robert Massie, 53, who was born with hemophilia and had contracted hepatitis C and HIV in the early 80s from donated blood products. Since Mr. Massie's non-liver cells made the missing enzyme that characterizes MSUD, he could receive Ms. Handler's liver.

According to Dr. Knechtle, domino transplants can effectively contribute to lessening the national shortage of organs available for transplant, though the conditions under which it can be performed are highly specific.

"Domino transplants are still quite rare because, in part, there are few illnesses that may impact one liver, but if that organ were to be given to another donor, would fail to negatively impact the health or quality of life in the recipient. In the case here at Emory, Ms. Handler's disease was one that would not impact Mr. Massie," says Dr. Knechtle. "And now, both patients are, in effect, living with new, perfectly functioning livers."

Liver transplants can be very challenging because of the intricately vascular nature of the organ. Domino transplants are even more so because one patient is both recipient and donor.

"Usually in a liver transplant, a diseased organ is removed from the recipient without the attached veins and arteries, with the new donated liver being attached to the recipient using his or her own tissue," says Dr. Hughes. "Because we had two recipients, one in turn also becoming a donor, we had to ensure that there were enough vascular structures to reattach both organs," explains Dr. Hughes. "Because we had to leave Jean with some of her own vessels, we needed to reconstruct the vessels from her liver in order to transplant it into Bob."

Both patients still remain in Atlanta in order to be monitored for complications and signs of organ rejection, but are very close to returning home.

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