Improved odds for liver surgery

Medics transplant livers of donors with a blood type different to recipients for first time, thanks to early use of antibody-fighting drug

PUBLISHED : Monday, 25 March, 2013, 12:00am
UPDATED : Monday, 25 March, 2013, 5:30am

A local medical team has transplanted livers from two donors to recipients of different blood types for the first time in the city, thanks to a new protocol.

The breakthrough at Queen Mary Hospital in Pok Fu Lam increased the chances of survival for liver disease patients who lacked a donor match from 50 per cent to 80 per cent, the University of Hong Kong's Professor Lo Chung-mau said.

Traditionally, liver disease patients who cannot be cured by having their tumours removed must wait for a liver from a deceased or living donor with the same blood type.

Such operations have a 90 per cent success rate.

Patients who cannot find a match undergo plasma exchange to reduce antibodies in their blood before accepting a donor from a different blood type. Transplants using this method have a 50 per cent success rate because of the possibility of organ rejection.

But by giving them rituximab before the plasma exchange, the antibodies are further reduced, meaning an organ from a donor of a different blood type is 30 per cent more likely to be accepted.

The first successful cases in the city were a man surnamed Lei, 62, from Macau, who received a liver from his son, and a Hongkonger surnamed Hung, 50, whose wife donated part of her organ.

They underwent surgery in January and earlier this month, respectively. Both suffered from cirrhosis caused by hepatitis B.

"I really wanted to save my husband but I couldn't [before the new protocol] because we have different blood types," Mrs Hung recalled. "At that time, I really felt like a knife was stabbing at my heart."

The hospital expects the number of living-donor liver transplants to increase 20 per cent after the breakthrough.

Lo, who is HKU head of surgery, said: "In many previous cases, the person who wanted to donate [the liver] might not be the ideal one, and so the patient had to ask for help from those whom they might not know … but we can now overcome this."

Dr Hwang Yu-yan, of the hospital's haematology department, said the drug had been used in combating lymphocyte cancer for many years.

Lo said medics in Japan had been using it for organ transplants between donors and patients of different blood types for two years.

He noted that post-surgery patients had to take a higher dosage of anti-rejection drugs, such as steroids, and the success rate for those already in an acute condition was 60 per cent.

Each year in Hong Kong, 10 to 15 patients miss out on liver transplants because they cannot get a donor with a matching blood type. One-fifth of such patients died while waiting for organs from deceased donors.