Liver transplant patients get a ray of hope

Maharashtra has scored a first as far as liver transplants are concerned.

In fact, the ABO-incompatible liver transplant that doctors at the Kokilaben Dhirubhai Ambani Hospital (KDAH) and Global Hospitals (GH) did was the first in western India itself.

In an ABO-incompatible liver transplant, the blood group of the recipient and the donor are not the same. In India, it has been done in New Delhi earlier.

After the transplant in Mumbai, Indrajit Singh (65) from Rajasthan, Mahesh Balasra (36) and Deepak Vashi (55) from Surat are all leading normal lives now. All of them had the same blood group (O+ve), with no suitable donors from their families.

The blood group of the donors were B+ve (son), A+ve (wife) and A+ve (son), respectively.

While the first and third transplants were done at KDAH, the second was done at GH, all last month.

"When we plan a liver transplant, one of the things we insist (or rather used to) was that the blood group of the donor and the recipient should be the same," said Dr Vinay Kumaran, head of the department, liver transplant and hepato-biliary surgery, KDAH.

Two other types of transplants are also possible. "Since the Rh group (+ve or -ve) does not matter, it can take place between a donor and a recipient with the same group. The other is between a donor with blood group O (universal donor) and a recipient with blood group AB (universal recipient)," he said.

This is one reason why the number of people waiting for liver transplants is high. Another is that organ donations from brain-dead donors are not enough.

"As a result, most patients waiting for liver transplant die waiting. Unlike kidneys, there is no equivalent of dialysis to keep these patients alive. In a desperate situation, transplants used to be done even if the blood groups were not compatible. The problem is that the patients have antibodies against the blood group antigens of the donor. These blood group proteins are present on the liver cells as well as the cells lining blood vessels. The result of these mismatched transplants was disastrous with severe antibody-mediated rejection," said Dr Kumaran.

Japan too had low organ-donation problems like India and they were the ones who did some pioneering work on liver transplants even with incompatible blood groups.

"We have adapted their method and started performing liver transplants across incompatible blood groups," said Dr Kumaran.

Dr Ravi Mohanka, chief surgeon and head of the department, Liver transplant and Hepato-Biliary Surgery at GH, said that liver transplant with incompatible blood group is challenging because of the additional risk of antibody-mediated rejection.

Such transplants require treatment of the patient to remove the blood group antibodies.

"There are various protocols, lasting from a month to a week. We currently follow the one-week protocol. First, we give the patient an injection of Rituximab- an antibody which binds to and kills the precursors of the B lymphocytes which are responsible for antibody production. Next, we use a form of plasmapheresis (filtering of blood) using a special filter called "Glycosorb", which binds to and removes only the blood group antibody from the blood. Once the antibody level is low enough, we can go ahead with the transplant," explained Dr Mohanka.

That's all doctorspeak. For the layman, will this mean those waiting for transplants don't die waiting for a liver anymore? "Yes, says Dr Mohanka." That is a huge sigh of relief.