New Technique of Blood Group Mismatched Donor for Liver Transplant

There is no more need of a blood group matching donor for liver transplantation as the Medanta Liver Team for the first time in India has introduced a newer method of blood group mismatched transplants. The team has already successfully treated three patients by this technique. The 43 old Khushwinder, 3 year old Zuana and 18 month old Karthikey are now living normal lives after undergoing this technique. Each one of them had O blood group and due to this they also had no appropriate family donors having a matching blood group. Owing to this mismatched blood group transplant technique, Khushwinder’s brother-in-law with blood group B, Karthikey’s mother with blood group B and Zuana’s grandmother with group A donated their respective livers.

Dr AS Soin Chief Liver Surgeon and Chairman of the Medanta Liver Institute explained this technique and said that “patients normally 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 neutralize 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 MD and chairman of Medanta explained that this is most complicated of all the transplants and zero-infection environment, high level of expertise, laboratory services and technology are required. Dr Neelam Mohan, Director of Pediatric Hepatology and Transplantation explained the background of the two transplanted children and said that Zuana was suffering from terminal liver failure and transplant was the only solution as there was no hope of survival. She was in coma and was also on ventilation for 10 days, and finally got out of it. The blood group of Zuana was O that did not match with any three medically suitable family donors. ABO-incompatible transplantation was then offered that used 20% of the liver of Zuana’s grandmother who was also having blood group A. This is the first procedure that was ever performed in India.

The family of Karthikey also decided to go through this procedure after 4 months. The blood group of Karthikey was O and he was suffering with Biliary Atresia with liver cirrhosis. A part of the liver was then donated by his mother having a blood group of B and he is now living a normal and a happy 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”.

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