Introduction: Organ shortages made it clear that liver transplantation (LT) alone was an inadequate method. Domino liver transplantation (DLT) is the use of an explanted liver from patients with a limited number of liver diseases, such as metabolic enzyme defect, as a graft for other suitable patients. DLT can be a important option for patients with low chances on the waiting list and who do not have a suitable donor to live a healthy life.  In this study, we presented three DLT and their results.
Method:
Case-1: First patient was a 12-year-old girl with primary hyperoxaluria type-1 (PH1). Liver function tests and liver biopsy was normal.  We performed left lobe LT from her mother and transplanted the liver, which was obtained from this girl with PH-1, to another 55-year-old patient with cryptogenic liver cirrhosis and hepatocellular carcinoma (HCC). Both patients were successfully discharged.
Case-2: The patient was a 5-year-old boy and was diagnosed with propionic acidemia (PA). He had epilectic discharges and had to eat a protein-restricted diet.  Liver function tests and biopsy were normal. We performed left lobe LT from his mother. We transplanted the liver we obtained from the patient with PA to our 6-year-old girl, who we transplanted liver for metabolic liver disease from her father 2 years ago but is currently in the process of chronic rejection. The recipients were discharged on postoperative day 8.
Case-3: A 2-year-old patient with mapple syrup urine disease (MSUD) underwent left lateral lobe LT from his father. Since the patient's liver function tests were normal and the biopsy was normal, we transplanted the liver graft obtained from the patient to a 6-year-old boy with familial hypercholesterolemia. Both patients were successfully discharged on postoperative day 9.
Results:  The patient with PH1 underwent kidney transplantation (KT) 1 month after LT. Eight months after KT, serum creatinine value was 0.8 mg/dL and there was no evidence of oxalate calculi in radiologic evaluations. The total bilirubin (T.bil) level of the patient diagnosed with HCC decreased from 3.7 mg/dl to 0.8 mg/dl in the first month after LT. Patients with PA and MSUD were not subjected to any dietary restriction after LT. In addition, no neurologic complications such as seizures were observed after LT. T.bil level of the patient diagnosed with metabolic liver disease after LT decreased from 26.7 mg/dl to 0.8 mg/dl in the 4th postoperative month.  The total cholesterol value of the patient with familial hypercholesterolemia decreased from 755 mg/dl to 263 mg/dl on postoperative day 8.
Conclusion: Domino LT, if performed carefully by selecting the right patients with the right indications, can be an important graft source for patients who do not have a suitable donor and are on the waiting list for liver transplantation.