Zuana had a liver transplant over ten years ago to beat terminal liver failure. It had been 13 years since the first successful liver transplant in India took place at the Apollo hospital in Delhi.
However, Zuana’s situation was unique. Her donor, her grandmother, did not have the same blood type as her, and it was Dr. Arvinder Soin‘s first such procedure.
“Our team began performing liver transplants in India 23 years ago, and we have performed over 3,600 cases since then.” Dr. Soin, who is now the chairman of the liver transplant department at Gurugram’s Medanta hospital and one of the surgeons who performed India’s first liver transplant in 1998, said.
In addition, he said, “Over the years, we have continuously tried to innovate to ensure that more liver patients can be saved and more people have access to the treatment.”
Liver transplant: ABO-incompatible transplants
Meanwhile, the use of blood group incompatible donors (also known as ABO-incompatible transplants) is one of the strategies to expand the donor pool, especially in a country like India where organ donation is mostly dependent on family.
Unlike most Western countries, where ‘died donor transplantation’ (the transplantation of organs from a brain-dead individual) is the norm, India uses alive donors in 85 percent of liver transplant cases.
Every year, between 2.5 and 3 lakh people in the country are diagnosed with liver disease or cancer, with over 50,000 of them being rescued by transplantation. There are fewer than 100 liver transplant centers around the country, which execute about 1,800 liver transplants each year.
A liver transplant registry was also established in 2019 to collect data from these centers on survival rates, problems reported, and immunosuppressants used in order to enhance care across the country.
When a family member’s blood type does not match that of the recipient, surgeons can use one of two methods: a swap or an ABO-incompatible transplant, which involves employing a donor with a mismatched blood type.
When the blood groups of the recipients of two distinct families match, an exchange is performed. On the same day, both donors and recipients are summoned to the hospital, and two transplant surgeries are performed concurrently.
This is only viable in high-volume centers with a large patient database, many operating rooms, and a large transplantation team.
“We’ve done it in approximately 60 couples with a 95% success rate. This is intriguing because both families have a medically fit donor, but they are unable to contribute to their family members for the transplant. In such circumstances, a swap can help,” according to Dr. Soin.
An ABO-incompatible transplant, on the other hand, represents a scientific challenge.
If a person is transfused with the wrong blood type, their immune system may have a violent reaction, including shock, kidney failure, and even death. So, how are surgeons able to transplant a complete organ from someone who has a different blood type?
To ensure the liver transplant procedure’s success, patients must undergo immunomodulation therapy three weeks prior to the transplant, which consists primarily of two steps.
One is the use of medication to destroy B cells that make antibodies against other blood types. Two, plasmapheresis is used to eliminate antibodies that are already present. Plasmapheresis is a method that separates the blood into its constituent components outside the body.
“What’s interesting is that the body adapts to the new liver with a different blood type in six to eight weeks after the liver transplant. The immunological reaction is only a temporary issue, and success with the immunomodulation regimen is only about 2% to 3% lower than with incompatible donors. As a result, it is an excellent alternative for patients who do not have a blood type match. This is what Zuana went through, and it was the first case of its kind in the country,” Dr. Soin added.
According to a later investigation, all eight children who had ABO-incompatible transplants at the center lived.