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Liver Transplant between Different / Mismatched / Incompatible Blood Groups – Views and Comments

By Jyotsna Verma Subscribe to RSS | May 23rd 2012 | Views:
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Liver Transplant Consultant, Jyotsna Verma, comments, “But one must keep in mind all pros and cons, facts related to such kind of surgery which involves more cost (about 25% or even more) and also increases risk related to Liver transplant specially in adults in comparison to children below 5 years of age. We not only need to increase the numbers of transplants but there is a need to increase the success rate of liver transplant by proper selection of patient and donor, conduct and close follow up of all post transplant patients. Also there is dire need that our Government should start Transplant Registry in India like other countries which are far ahead of us in Liver Transplantation so that patients opting for such surgeries must get full knowledge about the facts related to transplants”.

Dr. Vivek Vij, Chief Surgeon, Fortis Hospitals, Delhi and NOIDA, comments, “ABO incompatible transplants are feasible in liver and kidney transplant. Results are best in the children. This kind of liver transplant is recommended in children and adults in emergency settings only. New strategies like plasma exchange to decrease antibody count below 1:16, Rituximab and infusion of Prostaglandins E1 and Gabexate Mesylate into liver may improve outcomes and survival almost equivalent to ABO compatible liver transplant”.

Dr. Vinay Kumaran, Chief Surgeon, SGRH, Delhi, comments, “Transplantation of the liver from a donor with an incompatible blood group has been used in desperate situations where no other donor is available. The results, particularly in adults, have been inferior with higher mortality and more serious complications. Relatively better results have been obtained in infants. The cost of the protocols used to prevent antibody mediated rejection in such cases has led to reluctance to attempt this in India but there may be a role in selected cases”.

Dr Rahul Kakodkar, Senior Consultant Surgeon, Gurgaon Haryana, said, "The purpose of the entire treatment was to suppress the antibody levels in body to less than eight units for at least three weeks after the transplant so that the body adapts to the mismatched liver. This kind of transplant is not recommended for patients with Autoimmune Cirrhosis. Cost of the procedure is definitely increased but varies from patient to patient. “

Dr. Puneet Dargan, Senior Consultant Surgeon, Fortis, Noida and Delhi, comments, “ABO-incompatible live transplantation (ILT) is occasionally performed due to a relative high risk of graft failure. Knowledge of both graft and patient survival rate after ILT is essential for donor selection and therapeutic strategy. ABO-Incompatible liver grafts should be viewed as an important treatment option in selected adult patients with acute liver failure in need of an emergency liver transplant”.

"Thousands of liver transplants that could not happen because the donor's blood group was different from the one of the recipient can now happen. With this surgery, we have conquered the mismatch blood group barrier that did not allow many patients of organ failure undergo a transplant," Dr AS Soin, Chief liver transplant surgeon, Gurgaon, Haryana, said.

Dr Neelam Mohan, Paediatric hepatologist, Gurgaon, Haryana, said, "There was no cadaver donor even after waiting for six months. She had reached the stage of coma and her survival was dependent on the transplant. It was then that we decided to go for the mismatch blood group transplant (scientifically termed as ABO-incompatible transplantation).

Jyotsna Verma - About Author:
Author is India's most experienced Liver Transplant Coordinator. She worked with the
pioneers of this field when Liver Transplant in India was in its developing stage and has
been an invaluable asset in the development of Liver Transplant in India with Dr. A. S. Soin and Dr. Subash Gupta.
Her experience is unmatched in India in the volume of work she has done for patients and donors undergoing
liver transplant operations as well as counselling them and their families.  

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