Surgeons at Children’s Healthcare of Atlanta have performed what they believe to be the world’s youngest domino liver transplant (DLT). In this procedure, a patient with a metabolic disease receives a donor liver, and their original liver is then transplanted into another patient who has end-stage liver disease but does not have the metabolic disorder. The healthy liver can function normally in the new recipient as long as they do not have the underlying genetic defect.
The operation was led by Dr. Bhargava Mullapudi, surgical director of abdominal transplant at Children’s, and Dr. Richard Hendrickson, pediatric surgeon. Both are among the few physicians in the United States trained in both pediatric surgery and transplant surgery with experience in complex tumor removals. This marks the third domino transplant performed at Children’s Healthcare of Atlanta and the first where both patients were treated at this hospital.
Patient A, a two-year-old diagnosed at birth with a rare metabolic genetic disorder affecting protein processing, received a new donor liver. Their original liver was then transplanted into Patient B, age one, who suffered from another rare and potentially fatal liver disease. Because Patient B does not carry the genetic defect, their new liver is expected to function normally. The dual procedures took nearly 24 hours.
“A domino liver transplant is a very intricate and complex procedure involving careful coordination,” said Dr. Mullapudi. “Our teams recognized both patients were in our care at the same time and were similar in size. DLTs in such small patients can be technically challenging due to the size of the blood vessels. We worked meticulously to manage these simultaneous transplants to help both patients have the best possible outcomes.”
According to data from 1996 to 2020, only about 185 DLTs have been performed nationwide during that period. Physicians note that while rare, this technique increases organ availability for transplantation and helps address shortages on waiting lists.
“We’re proud to be on the leading edge of this new treatment path for patients with metabolic conditions and end-stage liver disease,” said Dr. Hendrickson. “Our teams continue to work hard and creatively to try to provide the best care for our patients to live long and healthy lives.”
After surgery, both children received care from hepatologists, anesthesiologists, and intensive care doctors at Children’s Healthcare of Atlanta as part of their recovery process. Although ongoing medication will be required for anti-rejection purposes, medical staff expect them to live without further complications related to liver disease.
Children’s multidisciplinary team offers comprehensive services before, during, and after transplantation procedures; since its program began in 1988 it has conducted more than 660 liver transplants. The team recently started using donor-derived cell-free DNA testing for noninvasive monitoring after transplantation—an approach designed to detect early signs of rejection while reducing reliance on biopsies.
