Disorders in
lipoprotein metabolism do not contraindicate liver procurement and
transplantation (LT). In this circumstance, LT provides an intriguing opportunity to assess the in vivo contribution of the liver to the synthesis and degradation of genetically polymorphic
plasma proteins.
Apolipoprotein (
APO) E exists with several common phenotypic differences due to gene polymorphism. Some authors have shown that the
APOE phenotype of the recipient was virtually completely converted to that of the donor, providing evidence that >90% of plasma
APOE arises from the liver. Homozygosis for
APOE2 (E2-E2) is related to an increased incidence of
type III hyperlipoproteinemia (HLP). Recently, some authors have identified 4 new
APOE mutations that are strongly linked to a unique entity of renal
lipidosis called
lipoprotein glomerulopathy (LPG). At present, 65 cases of LPG have been reported worldwide, although most patients have been discovered in Japan and other East Asian countries. We have herein reported a case of LT in a patient with advanced hepatocarcinoma who received a liver from a caucasian donor affected by type III HLP due to homozygous E2-E2. The LPG was due to a novel genetic mutation in
APOE. After the LT, the recipient, developed de novo severe
lipid abnormalities despite good graft function. To our knowledge this is the first report of an LT using a graft from a non Asian donor with homozygous E2-E2 with the presence of a novel
APOE mutation.