MUMBAI: Lack of a blood group matching donor no longer remains a barrier to liver transplantation. The Medanta Liver Team for the first time, have ushered in an era of successful blood group mismatched transplants in India (called ABO-incompatible transplant), with 3 patients already successfully transplanted by the technique, and several more waiting for the procedure.
Three year old Zuana, 18 month old Karthikey and 43 year old Khushwinder (Punjab) are now enjoying normal lives 15 m, 12 m and 5 months after transplant with mismatched blood group donors. All of them had blood group O and no suitable family donors of a matching blood group.
Zuana's grandmother of blood group A, Karthikey's mother with blood group B and Khushwinder's brother in law with group B donated their respective livers for the life-saving transplants.
Explaining the technique, Dr AS Soin, Chief Liver Surgeon and Chairman of the Medanta Liver Institute, said that"normally, patients have antibodies (proteins that can destroy the transplanted organ) against all other blood groups except their own. These antibodies can rapidly reject the transplanted liver. In order to make the patient accept such a liver (of a different blood group), these antibodies must be removed by a 3-pronged strategy, which starts one month prior to transplant. First, the antibodies are removed from the patient's body by washing the entire blood by several plasma exchanges. Second, we use 2 drugs called mycophenolate and anti-CD 20 to suppress the antibody-producing plasma cells, and third, intravenous IVIg is given to neutralise any remaining antibodies. This is then followed by the transplant with zero-error precision surgery to avoid blood vessel and bile duct problems, to which these patients are very susceptible", he added.
Dr N Trehan, the chairman and MD of Medanta, said that this type is the most complex of all transplants, and requires a combination of high level expertise, technology, zero-infection environment, and laboratory services. We are delighted that Medanta has been able to give this innovation to the country.
Explaining the background of the 2 transplanted children, Dr Neelam Mohan, Director of Pediatric Hepatology and Transplantation said Zuana was in terminal liver failure, with no hope of survival without a transplant. She was in coma and on ventilation for 10 days and then got out of it. Her parents were desperate to save her. Zuana's blood group was O and the blood groups of all 3 medically suitable family donors did not match with her. We then decided to offer her ABO-incompatible transplantation using 20% of her grandmother Naseema's liver who was of blood group- A. This was for the first time in India that we were doing such a procedure.
Fortunately all went well. After another 4 months the family of Karthikey decided to salvage him through this novel life saving transplant. It was a case of Biliary Atresia with liver cirrhosis and he was of blood group O. His mother with the blood group B donated a part of her liver to save him. Today, he is a delightful toddler living a completely normal life. "These transplants are a little less complicated for children less than 2 years since their ABO antibody levels are lower, and their ABO-i liver acceptance rates are higher", said Dr Mohan.
Dr S Saigal, Director of Transplant Hepatology at Medanta said"the pre-transplant preparation for ABO-i transplant is arduous, and requires extensive commitment of both the treating team and the patient's family. After the operation, it is vital to measure the antibody levels periodically, and clean the blood with more plasma exchanges if necessary. The body usually adapts to the ABO-i liver in approx 3 weeks.
Dr Soin said that the new technology was more than just a technical wonder - it raises new hope for thousands with organ failure whose donors get rejected due to mismatched donors and increase the transplant rate in the country by at least 30%.
This concept is revolutionary and will make 30% additional transplants possible. Among all our efforts to increasing organ donation, this technique is likely to make the biggest difference, he said.
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