In late November, doctors at Military Central Hospital 108 successfully performed a liver transplant involving incompatible blood types on a 20-year-old patient from Hanoi. The liver donor was her biological father. This was the hospital’s first adult case of ABO-incompatible liver transplantation and only the second of its kind in Vietnam.

17 years fighting primary sclerosing cholangitis

The woman had been living with illness since the age of three, when she first developed jaundice and yellowing of the eyes, requiring prolonged treatment at the National Children’s Hospital. A liver biopsy in 2015 confirmed she was suffering from primary sclerosing cholangitis - a chronic disease that leads to fibrosis and narrowing of both intrahepatic and extrahepatic bile ducts, resulting in bile obstruction, recurrent infections, and eventual cirrhosis and liver failure.

In 2017 and again in 2019, the patient underwent stem cell therapy to slow the progression of cirrhosis. A week before being admitted to Military Hospital 108, her jaundice worsened, the whites of her eyes became deeply yellow, and she began to experience dull pain in her right upper abdomen.

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The young woman endured 17 years of fatigue, jaundice, and abdominal pain. Photo: Provided by the hospital

Throughout those 17 years, her father - Mr. C. - stood by her side. He recalls one moment that has never left him: “When she was 10 years old, she woke up crying from a dream and said, ‘I couldn’t see you, Dad.’ I just held her and told her, ‘Mom and Dad will never leave you.’”

According to Dr. Vu Van Quang, Associate Professor and Deputy Head of the Hepatobiliary and Pancreatic Surgery Department, once the disease reaches an advanced stage, a liver transplant becomes the only viable option to improve both survival chances and quality of life.

When doctors recommended a transplant, Mr. C. did not hesitate. “We had already decided - I would be the one to donate,” he said. However, tests revealed that father and daughter had incompatible blood types, complicating the surgery significantly.

One of the most difficult medical challenges

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The complex surgery lasted seven hours. Photo: Provided by the hospital
Though Military Hospital 108 had previously performed three ABO-incompatible liver transplants, two of those were on pediatric patients. Dr. Vu Van Quang noted that the procedure is far more complicated in adults due to a mature immune system, higher levels of anti-A or anti-B antibodies, and increased risks of rejection and serious complications such as bile duct injury, thrombosis, or infection.

To prepare for surgery, the patient was given Rituximab and underwent plasmapheresis to reduce antibody levels to safe thresholds. During the transplant, the surgical team had to meticulously protect the graft’s endothelium, flush the liver, ensure proper blood flow, and connect the bile ducts with precision. After the operation, she was closely monitored for antibody levels, infection, and was placed on strong anti-rejection medication.

The procedure, which involved coordination across multiple specialties, lasted seven hours. Mr. C. underwent a laparoscopic procedure to remove the right lobe of his liver for transplantation. “Every single move had to be executed with absolute precision,” said Dr. Vu Van Quang.

A week after the surgery, both father and daughter were in stable condition, with good liver function recovery. It wasn’t until she saw her father again that the young woman broke down in tears - tears of love and relief at seeing her father healthy after his tremendous sacrifice.

Doctors say the transplant outcome is very promising. “This was the hospital’s first adult ABO-incompatible liver transplant and only the second in the country. It presented many challenges, but the team overcame them all,” Dr. Vu Van Quang shared.

The success of the transplant not only gave a new lease on life to a young patient but also opened up hope for others who lack compatible donors. Military Central Hospital 108 plans to continue developing this complex technique to reduce barriers for patients needing organ transplants.

N. Huyen