MIOT International has successfully performed a liver transplantation for the 1st time in the world, on a patient with anti-Kidd Jk(b) antibody positivity, a potentially dangerous and exceptionally rare blood-related immune condition.

55-year-old Patient with Chronic Liver Disease

Ms. Aminath Naifa, 55yrs old lady from Maldives came to MIOT in September 2024 with a diagnosis of Liver cirrhosis, in need of liver transplantation. It all started 2years back in June 2023 when Ms. Aminath Naifa started getting nose bleeds. Initially, she did not mind it but as time passed, the frequency of nose bleeds increased and persisted inspite of taking medications from a local physician. In November 2023 she started experienced blood vomiting which kept worsening with time.

After multiple visits to many hospitals, it was only at IGMH in Male her condition was diagnosed and stabilised with banding procedure for gastrointestinal bleeding. The veins in the oesophagus were enlarged, leading to blood vomiting which was a result of an underlying serious liver failure condition. During this critical phase, Ms. Aminath Naifa experienced brief memory loss, and doctors estimated her prognosis as grave, with only six months to live. She was then referred to MIOT Hospitals for Liver transplantation.  

Desperate to find a solution and know more about MIOT Hospitals, she visited MIOT’s medical camp in the Maldives. MIOT’s gastroenterology specialist reviewed her case, changed the medication which stopped her nosebleeds and explained in detail about her case and the process for liver transplant. Ms. Aminath Naifa and her family contacted MIOT’s local representative at Maldives who processed all her documents for travel, insurance and treatment.  With new born hope, Ms. Aminath reached MIOT Hospitals in September 2024 with her son and daughter.

They were received at the Chennai airport by the MIOT team. On reaching MIOT, the family met the liver transplant team who ran an array of tests on Ms. Aminath Naifa and diagnosed her with Decompensated Chronic Liver Disease. Her condition was even more complex due to her co-morbidities – enlarged spleen, diabetes, thyroid issues, cholesterol, and heart disease. On testing her family for matching Liver Donor, her son was a match (O+ve - Universal donor) and willing to donate.

Delighted about the news, the family flew back to their country for further approvals and insurance. With the approvals, Ms. Aminath Naifa and her son got admitted at MIOT in April 2025.

Identification of anti-Kidd Jk(b) Antibody During Pre-operative Tests at MIOT International

On cross matching the Patient (B+ve) and Donor (O+ve) Blood, there was a very negligible percentage of mismatch identified. Usually in many other centres such a mismatch would have been ignored. But the transfusion experts at MIOT, did further immuno-heamatology studies and identified the patient to have an anti-Kidd Jk(b) antibody positivity. This is a rare blood group in the Asian population. The Kidd antigens are expressed only on the membrane of the RBCs and kidneys. Anti-Kidd Jk(b) antibody positivity is notoriously difficult to detect in routine screenings due to its low titers and transient nature. In addition, exposure of Anti-Kidd Jk(b) antibody to its corresponding antigen can cause multiple complications, compromise the transplant, and potentially result in death.

Though the presenting titre may be low, the antibody can cause considerable challenges to transplant outcome and survival during and after the transplant. The identification of the condition by itself is a challenge requiring advanced technology like the “ORTHO VISION” and testing methods, on par with International standards, which is available only in a few hospitals in India like MIOT International.

Challenges Due to anti-Kidd Jk(b) Antibody

Anti-Kidd Jk(b) antibody-positive blood group, if undetected and transfused with non-matching, anti-Kidd Jk(b) antibody-negative blood, could cause blood clotting and bleeding in small vessels throughout the body. Such a mismatch can lead to the destruction of RBCs and serious complications such as acute kidney injury, potentially resulting in fatality.

Additionally, the necessary amount of the patient’s blood was not available to perform the surgery, as this Anti-Kidd Jk(b) antibody-positive blood group is very rare.

How MIOT’s Experts Overcame the Challenges?

A number of precautionary steps had to be taken for this transplant to be successful. The initial challenge was identification of matching Jk(b)-negative red blood cells to be transfused during and after the procedure. MIOT’s Department of Transfusion Medicine team cross-matched over 100 units of blood with the patient's blood and procured 6 units of matching Jk(b)-negative red blood cells.

Ms. Aminath Nafia was taken for surgery on 4th April 2025. During surgery, multiple steps had to be planned to minimise blood loss as a usual liver transplant procedure would require 12-15 units of blood. MIOT’s experts, through their precise surgical technique, used only 3 units of blood during the liver transplant procedure.

Post-surgery was the crucial phase. Close surveillance was carried out for any signs of organ rejection or RBC breakdown (haemolysis), or other haemolysis-induced complications. This risk was mitigated through constant monitoring of blood parameters.

Road to recovery

With such a complex scenario, every second post-surgery was like a ticking time bomb. But, as a result of the proper planning and precautions taken before the Liver transplant procedure, Ms. Aminath Nafia had a smooth recovery phase. Ms. Aminath Nafia came to MIOT in a much deteriorated state; Hb was only 7g/dL, loss of appetite ad weight, unable to even walk. Now 1 month post the liver transplant, her Hb is 13g/dL, she is able to walk independently and has regained her weight and appetite.

Successful Liver Transplantation - MIOT’s Gold Standard for Liver transplant Program

The program emphasises high-quality donor organs, experienced specialists, tedious and intricately planned cross matching process and state-of-the-art facilities, aiming for transplant outcomes on par with international standards.  This complex case demanded seamless coordination between MIOT’s transfusion medicine specialists, liver transplant surgeons and Anaesthesiologists. Given the rarity of the patient’s blood condition, the transfusion experts played a pivotal role in planning and executing personalised blood management strategies. From pre-transplant cross-matching and antibody identification to intraoperative blood salvage and real-time coagulation monitoring, their expertise ensured safe transfusion practices throughout the procedure.

With MIOT’s multidisciplinary excellence, advanced medical technology, transfusion medicine experts, and liver transplant specialists, the liver transplant was successfully completed without complications, ultimately saving the patient’s life. This extraordinary case pushed the frontiers of transplant medicine and underscored the life-saving impact of collaboration, precision, and innovation.