Preparing for the Next Transplant

As an update, here's where we are on the transplant track:

• Steve had a living donor transplant in 2/09, fraught with many complications and ultimately resulting in an "explantation" (removal of the transplanted kidney) at the end of March.
• His recovery was protracted; the wound was allowed to close with the help of a WoundVac--an ingenious combination of black sponge, a sealed surface, and a suction machine all tucked into a wearable "man purse." The wound was vacuous; you could have hid a small housecat in its depth. And the healing process took months.
• Steve's heart has also been an issue: starting with a bypass nine years ago, then three heart attacks during the transplant-related hospitalization, and another small one at Thanksgiving. He's had two stents placed in Ausugst, and an angioplasty at the Thanksgiving event.
• He needs to be on blood thinners because of the stents and because of an elevated clotting factor, Factor VIII.
• He continues on Home Dialysis five days a week.
• His antibody titre is close to 100% - which will make a crossmatch challenging.

Now for the better news:

• Steve has been working hard in cardiac rehab, and has actually gained fourteen pounds of lean body mass! Plus, he has no exertional symptoms.
• His diabetes is under very tight control, with a hemoglobin AlC hovering under six since he "came to Jesus."
• Living donor candidates are contacting  the Swedish Medical Center Transplant Clinic to get tested. He needs a donor with type A or O blood: the more tested, the better.
•  If Steve passes his nuclear medicine stress test in March, he will be a candidate again.

Now, his best results will come from a living donor, because he'll have to switch blood thinners in anticipation of a surgery. But he has accrued over 400 days of waiting time "on the list."

A planned surgery, i.e. done "by the light of day" with a fresh anesthesiologist and transplant surgeon will give Steve the best odds of success. The control of all "controllable factors" is critical.

Will we get there? I'm guessing we will. Steve keeps making milestones, bit by bit.

Plus, I've never seen anyone with the ability to land on his feet -- peripheral neuropathy and all -- like Steve Williams. Resilience, while unmeasurable by clinical standards, is one of the most potent weapons any patient has for survival.

Take care. Linda Gromko, MD