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Times of India
04 May 2013
New Delhi, India

Patients suffering liver failure may not have to wait without end to get a matching donor anymore.

Transplant surgeon claim those with mismatched donors can also undergo the life-saving procedure now with the help of a novel technique involving suppression of antibodies responsible for rejection of incompatible organs with the help of plasma exchange and drug therapy.

It has been used successfully to treat three patients at Medanta Medicity, Gurgaon. Now that all the three patients are doing fine, many others in the hospital want to follow suit.

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The first two blood group mismatched transplant, also referred to as ABO incompatible liver transplant, were conducted on two children Zuana (2) and Karthikey (1.6) and a 43-year-old man from Ludhiana. Dr A S Soin, chief liver surgeon and chairman of Medanta Liver Institute, said all of them had O+ blood group and no suitable family donors of a matching group.

“Zuana’s grandmother (blood group A), Karthikey’s mother with B and Khushwinder’s brother-in-law (also B) donated their respective livers for the life-saving procedure,” Soin said.

“Normally, patients have antibodies (proteins that can destroy a transplanted organ) against all other blood groups except their own,” Soin said. “The technique used to deal with this involves a threepronged strategy: washing the patient’s blood by multiple plasma exchanges to remove the antibodies, using drug therapy to suppress the antibody-producing plasma cells and giving intravenous blood product (IVIg) to neutralize any remaining antibodies,” Soin added. According to Dr Neelam Mohan, director of paediatric hepatology at the hospital, the chances of graft rejection in children, particularly those below one year, are lesser as they have much lower levels of blood group antibodies. “Both Zuana and Karthikey are doing fine after the transplants. They have started going to school also,” the doctor said.

In case of Khushwinder, she added, the procedure was riskier but he was saved. “My husband was on ventilator support for 23 days due to liver failure. He could not breathe properly and vomited blood constantly before he underwent the transplant. Now, he is fine,” said Khushwinder wife Sukhwinder Singh. The family spent close to Rs 25 lakh for the transplant procedure but still believes every penny spent was worth it.

Following the success in these three cases, doctors said, many other liver failure patients at the hospital are seeking to undergo the procedure. “We have at least three other patients lined up for the mismatched donor transplant over the next one month,” said Dr Sanjiv Saigal, director of transplant hepatology.

Medical experts say about 2.5 lakh people die due to liver failure every year in India. Of this, transplant can save 25,000, but only about a 1,000 get it.

“A majority of patients can’t afford the procedure that costs Rs 20 lakh approximately in a private hospital (few government-run hospitals have the facility). But there are some who die due to liver failure because they cannot find a matching donor. The success of ABO incompatible transplant gives a ray of hope for such patients,” said a doctor.

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