New transplant method offers hope to liver patients

Given that available organs for donation are scarce compared to the number of people requiring them, Bengaluru transplant surgeons are considering ABO-incompatible (ABOi) liver transplants in patients with severe disorders who cannot wait several months for a healthy organ. 

ABO (blood type) incompatibility means that the donor’s blood group does not match that of the patient. Normally, during the transplants of organs such as liver, this could have severe consequences due to antibodies in the patient’s body attacking the transplanted organ, causing the body to “reject” it. This meant that most, if not all, of the transplants, had to be ABO-compatible for the longest time. 

However, recent advancements in antibody absorption columns and drugs such as Rituximab that target B cells, have improved the results of ABOi liver transplants. This gives patients with severe liver disorders, such as cancer or cirrhosis, better access to a larger pool of healthy donors, note experts. 

“Without matching donors in their families, patients would have to normally wait six to nine months for a cadaver donation, which is a lot of time for patients who are too sick,” said Dr Suresh Raghavaiah, HoD and Senior Consultant - HPB, GI surgery and Multi-organ Transplant Surgeon Gleneagles BGS Hospital, Kengeri. 

Doctors first measure antibody titers to measure the concentration of antibodies and then do plasmapheresis to dilute this concentration. About three weeks before the transplant, they will be started on Rituximab to avoid a likely post-transplant rise in antibodies, explained Dr Raghavaiah. Immunosuppressants will have to be continued life-long. 

“The risk of rejection is highest within the first three months, where a greater dose of immunosuppressants is administered to patients and their vitals are closely monitored,” he said. 

However, while results have improved, these are still not as safe as compatible transplants, warned Dr Rajiv Lochan J, Lead Consultant – HPB, Liver Transplantation and Robotic Surgery, Manipal Hospitals. 

“In young children, because their antibody production is less, and in patients with liver tumours that don’t have any live donors and are on long waiting lists, we can consider ABOi. But the risk of antibody-mediated rejections remains, higher compared to ABOi kidney transplants,” he said. 

He added that immunosuppressants would also increase the risk of infections in patients who are very sick and might also risk cancer recurrence in liver cancer patients. “ABOi is sometimes used as a bridge while patients wait to get a compatible donor. We select such patients very carefully,” he said.

What this means ABOi liver transplants occur when the patient and donor both have different blood types, but advancements in technology and medicines prevent organ rejection.  Patients with severe liver conditions who cannot wait too long for a healthy liver and have no matching donors, can be considered.  Risk of rejection is highest within the first three months.  This would cost a couple of lakh rupees more than a compatible transplant but has shown comparable results.