In Liver Transplant Surgery, matching the blood group of the donor with the recipient is of utmost importance. Many patients who have some family member willing to donate liver face the problem of blood group incompatibility. One solution to this problem is Swap Donation. In this the Living Donors of two patients can be swapped. If a close relative of patient A has blood compatibility with patient B and the close relative of patient B has blood compatibility with patient A then swap liver transplant is possible.
Due to the problems in availability of a compatible Liver Donor amongst close relatives and the urgency of the Liver Transplant Surgery in India, the surgery is sometimes done with incompatible Blood Group.
This type of surgery is called Blood Group Incompatible Liver Transplant (ABOi LT). In such cases, the challenge is to prevent the rejection of the liver by the recipient's body. In the absence of pre-conditioning, transplantation across the blood groups is fraught with the almost universal risk of antibody-mediated rejection (AMR) that rapidly leads to graft loss.
In order to prevent the rejection of the liver some procedures need to be done. One of the procedure is to remove the spleen before doing Liver transplant surgery. Another option that is being used by the liver transplant surgeons in India is using Immunosuppressants one week before the Liver Transplant Surgery. Plasma treatment procedures also reduce the risk of rejection of liver from incompatible blood group. Children do not have a fully developed immune system and therefore the rejection of Liver in children is much lesser as compared to the adults.
ABO Incompatible Liver Transplant is not the first choice as yet in India and is resorted to only in emergency situations where the patient is not in a position to wait for either a deceased donor or a matching living donor.
India has much more Living Donor Organ Transplants as compared to Cadaveric Donors due to religious and social beliefs. Finding a donor with matching blood group amongst close relatives is therefore a big barrier in increasing the number of Liver Transplants. One way to overcome this hurdle is Swap Donation. Much work has been done in Asian countries in developing the programme of ABO Incompatible Liver Transplant Surgery. In India, the first liver transplant surgery was done in the year 1998 and the first 6 years saw less than 150 transplants in the entire country. Now India is doing close to 2000 Liver Transplant Surgeries per year at more than 30 transplant centres. The cost of Liver Transplant Surgery in India is only USD 50,000 as compared to USD 2,50,000 in most of the developed world.
As the outcomes of the ABO Incompatible Liver Transplant Surgery come close to those of the matched blood group, the potential of such surgeries would be immense. One of the biggest contributors in the success of Liver Transplant Surgery is for the patient to come early to the Liver Transplant Centre.
During the surgery, Liver transplant surgeon will give a long incision on the abdomen and remove the diseased liver and place the donor liver in the body of the recipient. The liver is then attached to bile ducts and blood vessels are connected. The surgery would take 8-10 hours and a team of liver transplant surgeons, anaesthetists and specially trained ot techs would assist the Chief surgeon.
Once the liver has been placed and connected, the surgeon will close the incision using stitches or staples. The patient is shifted to the ICU after the surgery. The hospital stay of the patient for Liver Transplant Surgery in India would be 25-30 days.
After the surgery, the patient is kept in intensive care unit (ICU) for 5-7 days for better care and continuous monitoring. Blood tests are carried out regulary to check your health parameters including the functioning of the new liver. Once all the health parameters are stable, the patient is shifted to the room. The stay in the room could be anywhere from 5 days to 25 days depending upon the speed of your recovery. Most of the patients who have been waiting for a long time for liver transplant do not have a good health so their recovery takes more time than those who get Living Donor Liver Transplant. Once you are discharged from the hospital, you will continue to recover at home. You would be required to get some blood tests while you are recovering. You will have to take several medicines during the recovery period which normally lasts for 6 months. Some medicines called immunosuppressants have to be taken lifelong. These medicines will suppress your immune system and prevent the rejection of the new liver by the body. However since these immunosuppressants reduce the immunity of your body, you will be more susceptible to other infections. You will therefore have to take much more care of your health as compared to other people who have not undergone such a surgery.
The cost of hospitalization, tests, surgery and medicines during your hospital stay in India would be Rs. 20 - 25 Lacs or USD 40-50 thousand for International patients. If you have to stay in a hotel after discharge from the hospital then that cost would be extra. Cadaveric Liver Transplant surgery has a good success rate and 5 year survival after the surgery is close to 70% at most of the centres in India. Dr. Ankur Garg has been the Chief Liver Transplant Surgeon at Nanavati Hospital before joining Metro Hospital, Faridabad.
At LivCure we have developed a programme which gives 360 degree solutions for all the problems of Liver and other Gastrointestinal Diseases.
Liver Transplant Surgery requires highest level of surgical skills and evidence based medical practices. Best Medical minds combined with cutting edge technology makes LivCure - The Premier Centre for Liver Diseases in India.
Dr. Ankur Garg
Liver Transplant & HPB Surgeon
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