We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Observation |

Amyloid Neuropathy Following Domino Liver Transplantation Response to Diflunisal

Pierre R. Bourque, MD, FRCPC1; Sharmi Shafi, MD1; Gerard H. Jansen, MD, FRCPC2; Arleigh McCurdy, MD, FRCPC3; Jodi Warman Chardon, MD, FRCPC1,4,5
[+] Author Affiliations
1Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
2Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
3Department of Hematology, The Ottawa Hospital, Ottawa, Ontario, Canada
4Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
5Department of Genetics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
JAMA Neurol. 2016;73(4):477-478. doi:10.1001/jamaneurol.2015.4715.
Text Size: A A A
Published online


This case report describes possible stabilization of liver transplant–acquired amyloid neuropathy with diflunisal.

The transmission of systemic transthyretin amyloidosis through domino liver transplantation, using a donor liver graft from a patient with familial amyloid neuropathy (FAP), was first described in 2005.1 This complication had not been expected, given that the onset of neurologic symptoms in cases of inherited amyloidosis typically occurs in the age range of 25 to 40 years. Accelerated deposition of amyloid in these types of liver recipients may be facilitated by the presence of amyloid fibrils in the donor liver, which act as a template for amyloidogenesis. We present a case with an unusually short latency of symptomatic onset in which therapy with diflunisal may have helped stabilize neuropathy and nephropathy while the patient waited for another liver transplant.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Sural Nerve Sections With Transthyretin-Amyloid Deposits in the Endoneurium of a Nerve Fascicle

Scale bars = 50 μm, and the arrowheads indicate the transthyretin-amyloid deposits that were revealed after staining.

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections