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ABO incompatible Living Donor Liver Transplant’ performed on a young woman patient with Budd-Chairi syndrome!

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Hyderabad, September 12, 2020: The Liver Transplant team led by Dr Manish Varma, Sr Consultant & HoD, Liver Transplant and HPB surgery and supported by Dr Naveen Polavarapu, Consultant, Gastroenterologist and Transplant Hepatologist, Apollo Hospitals, Hyderabad; successfully performed an ABO incompatible Living Donor Liver Transplant (ABOi LDLT) on a 19-year-old female patient from Warangal, Ms G. Soumya, suffering from a rare disease called Budd-Chiari syndrome. The patient has since recovered fully and is going about with her regular daily routine.

On being brought to Apollo Hospitals, she was found to be suffering from severe symptomatic hepatic hydrothorax, a condition which led to excessive accumulation of fluid in the lungs and abdomen and swelling in the body resulting in breathing difficulty. On investigation she was found to have liver cirrhosis due to Budd-Chiari Syndrome, a rare condition caused by blood clots that completely or partially block blood flow from the liver.

The patient was suffering from this ailment for the past two years, though she was initially managed with medicines at Vijayawada, her condition worsened with fluid accumulation in the lungs and was virtually threatening her life. She needed repeated withdrawal of fluid from the lungs by needle puncture, once in every ten days. Such patients have a high risk of catching lung infections and it persists till the patient undergoes a transplant.

Ms Soumya was on regular follow up with the Liver Transplant Team at Apollo Hospitals for the past 4 months and a liver transplant was advised. As none of her family members had a matching blood group to donate a slice of their liver, she was waiting for a cadaveric organ for liver transplant for the three months prior to surgery. As her condition was deteriorating rapidly with no hope of a dead donor organ coming her way, she was advised by the Liver Transplant Team at Apollo Hospitals, an ABOi Living Donor Liver Transplantation.

Body’s immune system is averse to accepting organ of a different Blood group and rejects such alien tissue. Therefore, same blood group donors are preferred for organ transplantation. However, ABOi Living Donor Liver Transplantation procedure enables to seek a piece of liver from the available donor irrespective of the blood group they belong to. Also known as mismatched blood group liver transplantation, is a very rarely performed procedure and only very few centres across the world have the expertise in performing this surgery. Even in Telangana, Apollo Hospitals, Hyderabad, is the only centre performing it.

Liver transplantation is the only hope for end-stage liver disease patients, fetching a liver slice from the same blood group living donor is a humongous task, so is cadaver organ with the demand far outstripping supply. The way out for patients on death bed is the ABO incompatible living donor liver transplantation. With Liver cirrhosis reaching epidemic proportions, ABOi will be a beacon of hope for patients, says Dr Manish Varma. This is a gamechanger procedure for patients needing liver transplant and presents a silver lining for patients especially in the circumstance we are currently in, with not many cadaver livers being available for terminally ill patients and most of the times close relatives may not be of the same blood group. The Apollo Hospitals Liver Transplant program has been clocking a success rate of 95 to 96%, which is on par or even better than many of the world’s best Liver transplant programs.

The patient Ms Soumya said, I used to suffer from bloating stomach and swelling of legs. To get treated I approached a gastroenterologist in Warangal, they identified it as a liver problem and referred us to Apollo Hospitals. I was advised Liver Transplant but my blood group being ‘O’, getting a liver of that blood group was difficult. They ultimately opted for my mother as donor though her blood group is ‘A’, but this new technique enabled the transplantation. Now I am free of swelling, breathlessness has subsided, I am in a position to walk without difficulty and lead a normal life.

Dr Naveen Polavarapu said, when she came to us, we tried to salvage her liver through medical treatment but the blocks in the blood vessels were hardened, there didn’t seem to be any other option than Liver transplantation. As her condition was deteriorating, we had to refer her for liver transplant. We had sourced 60% of the liver of her mother and transplanted it in the patient. In two months’ time their respective livers in both mother and daughter will regain their full size. Though mother was of a different blood group, using the new technique ABOi LDLT, a mismatched blood group liver transplant was done. At Apollo Hospitals we have done over 300 liver transplants with very good outcomes.

For Soumya, her mother, though from a different blood group, donated a slice of her liver. The preparation for the surgery started 3 weeks prior with her receiving medicines to minimise chances of rejection. She also underwent multiple sessions of plasmapheresis (a dialysis like procedure for reducing antibodies in the blood). The surgery was performed on the patient on 11th August, 2020. The entire operation from start of donor surgery to end of recipient surgery took 15 hours. The patient and her mother have since recovered and are doing well. The patient had an uneventful post-operative course and was discharged on 10th day and her mother on the 6th day post-surgery. 1 month post-surgery she is doing fine, her liver is functioning normally and she has not required any more fluid removal from her lungs. She is presently on blood thinners to prevent blood clot formation in view of previous Budd-chiari syndrome. The blood thinners will continue for a few more weeks. She will need to be on lifelong medication and regular follow-up, just like all other transplant patients.

Dr Ravindra Babu, Medical Superintendent, Apollo Hospitals, Hyderabad, speaking on the occasion said, Liver transplant itself is a complex surgery, this new technique, ABOi LDLT is a major milestone and opens doors for many more end stage liver cirrhosis patients to survive and come out of the trauma which is nothing less than a deathbed.

About Apollo Hospitals
It was in 1983, that Dr. Prathap Reddy made a pioneering endeavor by launching India's first corporate hospital - Apollo Hospital in Chennai. Now, as Asia largest and most trusted healthcare group, its presence includes 8,488 beds across 51 Hospitals, 1,586 Pharmacies, 92 Primary Care and Diagnostic Clinics, 100 Telemedicine units across 10 countries. Health Insurance services, Global Projects Consultancy, 15 colleges of Nursing and Hospital Management and a Research Foundation with a focus on global Clinical Trials, epidemiological studies, stem cell & genetic research and the first Proton Therapy Centre across Asia, Africa and Australia.

In a rare honour, the Government of India issued a commemorative stamp in recognition of Apollo's contribution, the first for a healthcare organization. Apollo Hospitals Chairman, Dr. Prathap C Reddy, was conferred with the prestigious Padma Vibhushan in 2010. For more than 28 years, the Apollo Hospitals Group has continuously excelled and maintained leadership in medical innovation, world-class clinical services and cutting-edge technology. Our hospitals are consistently ranked amongst the best hospitals globally for advanced medical services and research.

Updated on September 12, 2020