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Neuromuscular disease
Systemic but asymptomatic transthyretin amyloidosis 8 years after domino liver transplantation
  1. Haruki Koike1,
  2. Tetsuya Kiuchi2,
  3. Masahiro Iijima1,
  4. Mitsuharu Ueda3,
  5. Yukio Ando3,
  6. Saori Morozumi1,
  7. Minoru Tomita1,
  8. Yuichi Kawagashira1,
  9. Hirohisa Watanabe1,
  10. Masahisa Katsuno1,
  11. Yoshie Shimoyama4,
  12. Yasumasa Okazaki5,
  13. Hideya Kamei2,
  14. Gen Sobue1
  1. 1Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
  2. 2Department of Transplantation Surgery, Nagoya University Hospital, Nagoya, Japan
  3. 3Department of Diagnostic Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
  4. 4Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
  5. 5Department of Pathology and Biological Response, Nagoya University Graduate School of Medicine, Nagoya, Japan
  1. Correspondence to Professor Gen Sobue, Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; sobueg{at} Haruki Koike, Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; koike-haruki{at}


As familial amyloid polyneuropathy (FAP) is an adult-onset disease, a long period is expected between domino liver transplantation (DLT) and the occurrence of amyloidosis in recipients of a FAP liver. However, as time passes, and increased numbers of patients have undergone DLT, patients with symptoms suggesting amyloidosis have been reported. The authors describe, for the first time, pathological findings in an autopsy case of a recipient of a FAP liver. A male patient with primary sclerosing cholangitis received a liver graft from a FAP patient with the transthyretin (TTR) Tyr114Cys mutation when he was 30 years old. Although a recurrence of primary sclerosing cholangitis was detected at age 34, he had no symptoms indicating amyloidosis. He died from Burkitt's lymphoma at 38 years of age. TTR immunoreactive amyloid was found in various organs including the heart, lung, gastrointestinal tract, pancreas, spleen, reproductive system and skeletal muscles. In the nervous system, TTR immunoreactive amyloid deposition was obvious in the sympathetic ganglia and the median nerve within the carpal tunnel, while loss of neurons or nerve fibres was not apparent. This case allows for the characterisation of amyloid deposition during the asymptomatic stage of FAP. Widespread amyloid deposition may occur before tissue damage in this disease.

  • Familial amyloid polyeuropathy
  • domino liver transplantation
  • amyloid
  • transthyretin
  • neuropathy
  • pathology

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  • Funding This work was supported by grants from the Ministry of Health, Labour and Welfare and the Ministry of Education, Culture, Sports, Science and Technology of Japan.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the Nagoya University Graduate School of Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.