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Heart-liver-kidney transplantation for AL amyloidosis using normothermic recovery and storage from a donor following circulatory death: Short-term outcome in a first-in-world experience.

Author information

Affiliations

  • 1. Department of Surgery, Division of Transplant and Hepatobiliary Surgery, University of California San Diego, San Diego, California, USA.
      Authors
    • Brubaker AL 1
    • Taj R 1
    • Parekh JR 1
    • Berumen J 1
    • Schnickel GT 1
    (5 authors)
  • 2. Department of Medicine, Division of Cardiology, University of California San Diego, San Diego, California, USA.
      Authors
    • Urey MA 2
    • Tran H 2
    • Adler ED 2
    • Silva Enciso J 2
    (4 authors)
  • 3. Department of Surgery, Division of Cardiothoracic Surgery, University of California San Diego, San Diego, California, USA.
      Authors
    • Kearns M 3
    • Pretorius V 3
    (2 authors)
  • 4. Department of Medicine, Division of Nephrology, University of California San Diego, San Diego, California, USA.
      Authors
    • Shah M 4
    • Khan A 4
    (2 authors)
  • 5. Department of Medicine, Division of Hepatology, University of California San Diego, San Diego, California, USA.
      Authors
    • Kono Y 5
    • Ajmera V 5
    • Barman P 5
    (3 authors)
    • Show all (8)

ORCIDs linked to this article

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 12 Jan 2023, 23(2):291-293
https://doi.org/10.1016/j.ajt.2022.11.003 PMID: 36804136 

Abstract 

AL amyloidosis is a rare condition characterized by the overproduction of an unstable free light chain, protein misfolding and aggregation, and extracellular deposition that can progress to multiorgan involvement and failure. To our knowledge, this is the first worldwide report to describe triple organ transplantation for AL amyloidosis and triple organ transplantation using thoracoabdominal normothermic regional perfusion recovery with a donation from a circulatory death (DCD) donor. The recipient was a 40-year-old man with multiorgan AL amyloidosis with a terminal prognosis without multiorgan transplantation. An appropriate DCD donor was selected for sequential heart, liver, and kidney transplants via our center's thoracoabdominal normothermic regional perfusion pathway. The liver was additionally placed on an ex vivo normothermic machine perfusion, and the kidney was maintained on hypothermic machine perfusion while awaiting implantation. The heart transplant was completed first (cold ischemic time [CIT]: 131 minutes), followed by the liver transplant (CIT: 87 minutes, normothermic machine perfusion: 301 minutes). Kidney transplantation was performed the following day (CIT: 1833 minutes). He is 8 months posttransplant without evidence of heart, liver, or kidney graft dysfunction or rejection. This case highlights the feasibility of normothermic recovery and storage modalities for DCD donors, which can expand transplant opportunities for allografts previously not considered for multiorgan transplantations.

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Read article at publisher's site: https://doi.org/10.1016/j.ajt.2022.11.003

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