Lahore: In a landmark achievement for organ transplantation in Pakistan, the Pak Kidney and Liver Institute and Research Center (PKLI&RC) has successfully carried out the country’s first planned domino auxiliary liver transplant, using a single mother’s liver donation to treat two children suffering from rare genetic liver diseases.
The highly specialised surgery was performed by a liver transplant team led by Prof Dr Faisal Saud Dar, Dean of PKLI&RC, who has now performed more than 2,500 liver transplants, placing him among the most experienced transplant surgeons in the region.
Prof Dar said the procedure demonstrated how advanced transplant techniques could help overcome severe organ shortages while saving multiple lives. He added that only a handful of similar cases have been reported internationally, and for the specific indications and transplant configuration used in this case, it may be the first of its kind globally, though the team is in the process of verifying this through published medical literature.
He explained that the case involved a carefully planned domino transplant using two partial liver transplants. In the first stage, a mother donated a small portion of her liver, known as the left lateral segment, to her child suffering from Crigler–Najjar syndrome type I, a rare inherited condition that causes dangerously high bilirubin levels from birth.
Instead of removing the child’s entire liver, surgeons attached the donated portion alongside the existing liver, an approach known as auxiliary liver transplantation. This allowed the new liver tissue to correct the metabolic defect while the child’s own liver remained in place.
Following stabilisation, doctors removed the child’s own left lobe of the liver. Although structurally healthy, it could not process bilirubin properly due to the underlying genetic disorder.
This removed portion was then transplanted into another child suffering from homozygous familial hypercholesterolaemia, a rare and severe genetic condition that causes extremely high cholesterol levels from early childhood and significantly increases the risk of premature heart disease.
Prof Dar said this step-by-step approach allowed surgeons to treat two different genetic diseases using tissue from a single donor. “This is known as a domino transplant, where the liver removed from one patient becomes a lifesaving graft for another,” he explained.
All three patients, including the mother who donated part of her liver, recovered smoothly after surgery. The donor was discharged on the fifth day after the operation, while the first child was discharged on the seventh day and the second child on the eighth day.
Post-operative outcomes were encouraging. Bilirubin levels in the child with Crigler–Najjar syndrome returned to normal, while cholesterol levels in the second child dropped sharply, falling from over 1,000 mg/dL before surgery to below 400 mg/dL shortly after transplantation.
Prof Dar said the success of this case highlights the growing potential of domino and partial liver transplantation in Pakistan, particularly for children with inherited metabolic disorders. “With careful planning and surgical expertise, one donor organ can be used to save more than one life,” he said.
PKLI&RC, a state-of-the-art tertiary care hospital, has rapidly emerged as a national referral centre for kidney and liver diseases, with its transplant programme increasingly undertaking complex and high-risk cases that were once considered beyond Pakistan’s capacity.
Doctors say the success of Pakistan’s first planned domino auxiliary liver transplant not only places PKLI&RC among advanced transplant centres worldwide but also offers renewed hope to families affected by rare liver disorders, reducing the need for costly treatment abroad.