9-Month-Old Undergoes Rare Incompatible Liver Transplant; know what the high-risk procedure is

Doctors say only five such incidents have been recorded worldwide so far

New Delhi: The infant, Vayu Visavadia, was diagnosed with biliary atresia, a rare condition characterized by a complete absence of extrahepatic bile ducts at birth when he was just six days old.
Doctors at Nanavati Hospital in Mumbai desensitized Vayu’s blood to remove antibodies so her body would not reject the transplanted liver, part of which was donated by her aunt. The team planned an ABO incompatible liver transplant because Vidhi Visavadia’s blood type is A+ve while Vayu’s is O+ve.
Doctors said that although there were several hurdles before the operation began, it was finally completed on August 18. “In the medical literature, only five such incidents have been recorded in the world,” Dr Anurag Shrimal, Director, Surgery, at Nanavati Hospital, told media. Dr Shrimal said Vayu is currently recovering in hospital and will be discharged soon after carrying out some tests.

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How was the operation prepared?

Dr. Shrimal said that for the preparation of an incompatible liver transplant, Vayu first received Rituximab, an antibody against the CD20 cells responsible for this antibody production, then a plasma exchange session to eliminate the preformed antibody.

Vayu underwent corrective surgery two weeks after birth to allow bile drainage. However, the procedure was unsuccessful and developed decompensated chronic liver disease with jaundice and other complications. Dr Shrimal also said that a day before his transplant, Vayu’s chest scan again showed suspicion of pneumonia. But the infection was cured.

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What is biliary atresia?

Biliary atresia or BA is a progressive fibro-obliterative disorder of the intrahepatic and extrahepatic bile ducts that appears during the first three months of life. It occurs worldwide, affecting around 1 in 8,000 children.

Even though doctors recommend early diagnosis of BA because it is essential to prevent the rapid progression of liver damage and the development of cirrhosis, unfortunately, the majority of affected children eventually develop end-stage liver disease.

What is an incompatible liver transplant?

Although it is an infrequent procedure, doctors say that ABO-I liver transplantation is now possible. But antibody-mediated rejection remains a critical problem that impairs graft liver function.

Researchers around the world are trying to develop a preoperative preparation with rituximab and plasma exchange to reduce anti-A and B isoagglutinin titers to prevent antibody-mediated rejection and postoperative local infusion to prevent vascular occlusion.

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