Iatrogenic amyloid polyneuropathy after domino liver transplantation

Table 1 De novo transthyretin amyloid neuropathy cases after liver transplantation

Ref.	TTR mutation	Age at transplant	Latency (yr)	Cause of liver failure	Initial Neuropathy symptoms
[14]	Val30Met	61	8	HCV EtOH	Pain
[14]	Val30Met	35	5	HBV	Pain
[14]	Val30Met	26	3.5	HCC	Pain, erectile dysfunction
[14]	Val30Met	28	5	HBV	Pain
[14]	Ser77Tyr	57	2	HCC HBV HCV	Pain
[14]	Leu58Hys	60	0.17	HCV HIV	Pain, weakness
[14]	Thr49Ala	49	2	HCC HCV	Pain, orthostatic hypotension
[15]	Glu54Gly	43	9	HCC	Diarrhea, pain, sensory loss
[16]	Val30Met	60	7	HBV cirr	Pain
[17]	Gly 47Glu	65	10	HCC	Pain
[18]	Val30Met	54	9	HCV	Pain, erectile dysfunction
[19]	Ser23Asn	72	0.5	NASH	Sensory loss, pain
[20]	Val30Met	50	7	PBC	Sensory loss
[21]	Val30Met	35	10	PSC	Pain, sensory loss
[22]	Val30Met	59	12	HBV HCV cirr	Pain, sensory loss
[23]	Val30Met	47	8	HCV cirr	Pain

PBC: Primary biliary cirrhosis; NASH: Nonalcoholic hepatic steatosis; EtOH: Alcoholic liver cirrhosis; HBV: Hepatitis B virus; HCV: Hepatitis C virus; cirr: Cirrhosis of the liver; PSC: Primary sclerosing cholangitis; HCC: Hepatocellular carcinoma.

Table 2 Evaluation and monitoring of possible de novo amyloidosis after domino liver transplantation

Clinical presentation	Signs and symptoms	Testing
Dysautonomia (small fiber neuropathy)	Orthostatic hypotension	Tilt table testing
	Sweating abnormalities (anhidrosis)	QSART with autonomic battery
	Constipation/diarrhea	ECG
	Erectile dysfunction	Neurologic examination
	Neuropathic pain
	Arrhythmia
	Neurogenic bladder
Large fiber polyneuropathy	Sensory loss	EMG/NCS
	Weakness	Nerve (and muscle) biopsy
	Neuropathic pain	Neurologic examination
	Ataxia
	Areflexia
Cardiac amyloidosis	Fatigue	ECG
	Arrhythmia	Transthoracic echo
	Syncope	Radionuclide imaging
	Orthostatic hypotension	Cardiac MRI
		Endomyocardial biopsy
		BNP/troponin
Gastrointestinal amyloidosis	Constipation/diarrhea	GI tract biopsy
	Nausea/vomiting
Ocular amyloidosis	Dry eye	Ophthalmologic evaluation
	Vitreous opacity
	Glaucoma
Leptomeningeal amyloidosis	Cerebral infarction/hemorrhage	MRI of brain and spinal cord
	Hydrocephalus	Meningeal biopsy
	Ataxia
	Spastic paresis
	Seizures
	Dementia
Other system involvement	Coldness	Rectal and abdominal fat biopsy
	Weight loss	Salivary gland biopsy
	Peripheral edema	TSH
	Anemia	Urinalysis/urine protein collection
	Dry mouth

QSART: Quantitative sudomotor axon reflex test; ECG: Electrocardiograph; EMG/NCS: Electromyography and nerve conduction studies; MRI: Magnetic resonance imaging; BNP: Brain natriuretic peptide; GI: Gastrointestinal; TSH: Thyroid stimulating hormone.