Lipid profile effects on donor and recipient of a domino liver transplant with heterozygous familial hypercholesterolemia.

[BACKGROUND] Familial hypercholesterolemia (FH) is caused by genetic mutations in lipid metabolism that increase atherosclerotic cardiovascular disease (ASCVD) risk.

[OBJECTIVE] We wanted to assess lipid profile effects of liver transplant in i) a donor patient with heterozygous FH (HeFH), and ii) a HeFH recipient patient with colorectal adenocarcinoma with isolated liver metastasis.

[METHODS] A 34-year-old donor female with HeFH and intolerance to all lipid lowering therapies underwent living donor HeFH-negative liver transplant. Her HeFH liver was subsequently transplanted into a 49-year-old recipient female with colorectal adenocarcinoma with isolated liver metastasis, despite surgery and chemotherapy.

[RESULTS] Donor patient with HeFH who got HeF H negative liver transplant had significant improvement in lipid panel to the point of no longer requiring lipid lowering therapy. Post-liver transplant, hyperlipidemia developed in the recipient of the HeFH liver, though not quite to the level of the donor baseline, suggesting physiologically functioning extrahepatic LDL receptors' contribution to some LDL-C clearance.

[CONCLUSION] Utilizing HeFH liver transplant, combined with aggressive treatment of dyslipidemia can be used to potentially salvage higher risk patients with isolated liver metastasis from colon cancer.