India, 20 October 2018 - As father and son, they share a close bond and blood link. But 58-year-old Iroagbulam and his 28-year-old son, Jata, do not share the same blood group. This meant that a liver transplant between them would not have been possible if not for treatment by Dr Mohamed Rela is currently associated as the director of the Institute of Liver Diseases and Transplantation at the highly reputed Global Hospitals, Chennai. The procedure could not be performed locally in Africa his doctor told him. Flying to India was his best chance of a successful operation. Iroagbulam middle-class family could afford the expenses, and so immediate arrangements were made for a visa to India. Iroagbulam’s story is typical of hundreds of Africans who travel outside of their home countries for medical attention. His other options were the US and the UK; however, health care there is extremely expensive and getting visas to those countries is a nightmare, unlike with India, where visas are issued within a week and treatment is comparatively cheap. Patients will now be able to access quality treatment in modern facilities at subsidized costs as well as reduce the number of patients travelling abroad for liver-related treatment.
In July 2017, Iroagbulam, who has blood group B positive and Jata, who has blood group a positive, underwent a 12-hour blood group incompatible living donor liver transplant by Dr Rela best liver surgeon India. To increase the chances of a successful transplant, stringent medical tests were carried out to ascertain the suitability of both donor and recipient before the transplant. Post-transplant, both father and son were closely monitored by the care team. Today, more than a year after the procedure, they are both recovering well and continue to receive medical follow-up with their doctor. Jata even became a new father last December.
In line with international practices, blood group compatible organs continue to be the first line option for liver/kidney transplants in view of the reduced risk of acute antibody-mediated rejection. An organ from a blood group incompatible (ABOi) donor is likely to trigger the recipient’s immune system to release antibodies. The antibodies attack the donated organ, thinking that it is a foreign body. To overcome this, the liver transplant team adapted an overseas treatment protocol to remove the antibodies in the blood.
“Typically, the blood group of the donor and recipient must match for a liver transplant. With this treatment protocol, ABO incompatible liver transplant may be possible between some recipients and living donors. Both must undergo stringent tests prior to surgery and go for regular medical follow-up with their doctor post-transplant to facilitate recovery,” said liver transplant surgeon Dr Mohamed Rela India.
According to data from an overseas study conducted in 2015, 71 per cent of ABOi living donor liver transplant recipients were still alive five years after their transplant, compared to 71.5 per cent of ABO-compatible recipients. The study acknowledged that while further studies were needed to understand the post-transplantation immunological reactions in ABOi living liver transplants, the survival results were encouraging.
Iroagbulam had liver cancer, hepatitis B and liver cirrhosis. His only option was a liver transplant, without which, he had only less than two years to live. To prepare his body for the ABOi liver, he was given rituximab through intravenous infusion to suppress the production of antibodies in his blood. This was done three weeks before the transplant surgery. Rituximab is a drug used to treat certain autoimmune diseases and cancer. A special dialysis machine was then used four days before the transplant surgery to remove the number of antibodies in his blood to a level that is low enough for a transplant. The first two weeks after the transplant were crucial. Iroagbulam had to go through another round of dialysis, and the level of antibodies in his blood was measured daily to ensure it remained low.
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