# Iatrogenic Amyloid Polyneuropathy Following Domino Liver Transplantation: A Case Report

## TL;DR

A man who received a liver transplant from a donor with a genetic disorder later developed a rare nerve disease caused by the transplant.

## Contribution

This case report highlights the challenges of diagnosing iatrogenic amyloid polyneuropathy following domino liver transplantation.

## Key findings

- A 68-year-old man developed symptoms consistent with iatrogenic amyloid polyneuropathy after receiving a domino liver transplant.
- The case emphasizes the need for increased awareness and structured monitoring of domino liver transplant recipients.
- Early recognition of symptoms in such patients is crucial for timely diagnosis and management.

## Abstract

Familial amyloidotic polyneuropathy (FAP) is an autosomal dominant hereditary disorder. In Portugal, it is mainly linked to transthyretin (TTR) mutation, and patients present with length-dependent sensory-motor polyneuropathy, often accompanied by autonomic dysfunction. Treatment options for FAP include liver transplant, and due to the lack of organs, FAP livers began being implanted in patients with severe liver disease in a process known as domino liver transplantation (DLT). We report a case of a 68-year-old Portuguese man, with post-hepatitis C-related cirrhosis liver transplantation, who presented to his family doctor with decreased sensitivity in both feet and weight loss, which were initially attributed to diabetic neuropathy and an adjustment in diabetic medication, respectively. Symptoms evolved to changes in both feet's thermal and painful sensitivity, reduced sensitivity in both hands, diarrhea, and progressive weight loss. At this time, the patient's disclosure of receiving a DLT prompted the correct diagnosis of iatrogenic amyloid polyneuropathy. This case underscores the challenges in diagnosing and managing iatrogenic amyloid polyneuropathy following DLT, highlighting the importance of prompt identification of DLT recipients, active vigilance of these patients via structured monitoring, and increased healthcare providers' awareness of this practice so that early signs of the disease may be recognized.