June 13, 2013 3:23:07 am
Overcoming the odds of blood group mismatch,a team of doctors of Medanta Hospital in Gurgaon have successfully completed three liver transplants where the donors blood group did not match that of the receiver.
Doctors believe this medical breakthrough,which is called ABO-incompatible transplant,will increase liver transplant rate by 30 per cent. Until now,the procedure was performed for patients needing kidney transplant at several hospitals,including AIIMS.
At Medanta,the three patients Zuana (3),Karthikey (18 months) and Khushwinder (43) belonged to blood group O and did not have a compatible donor in the family.
Doctors said its has been 15 months since Zuana underwent the surgery,a year for Karthikey and five months for Khushwinder.
Zuana found a donor in her grandmother with a blood group A,Karthikeys donor was his mother with blood group B and Khushwinders brother-in-law,who has group B,stepped in as donor.
Dr A S Soin,chief liver surgeon and chairman of Medanta Liver Institute,antibodies in a patients usually work against an organ transplanted from a different blood group. In order to make a patient accept a liver of a different blood group,antibodies are removed through a three-pronged strategy,which starts one month prior to transplant.
First,the antibodies are removed by washing patients entire blood by several plasma exchanges. Second,we use drugs 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, Soin said.
Dr Naresh Trehan,chairman and MD of Medanta,said it a complex procedure and requires a combination of high-level expertise,technology,zero-infection environment and laboratory services.
Dr Neelam Mohan,director of paediatric hepatology and transplantation,said Zuana was in terminal liver failure stage,with no hope of survival without a transplant. She was in coma and on ventilation for 10 days.
We then decided to offer her ABO-incompatible transplantation using 20 per cent of her grandmother Naseemas liver,who was of blood group A, she said.
Karthikeys was a case of biliary atresia with liver cirrhosis.
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, Dr Mohan said.
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 patients 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 approximately three weeks, Dr Saigal said.
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