Wednesday, February 17, 2010

Anniversary of a Failed Transplant

Some time ago, I wrote about "Anniversary Phenomenon:" that vague sense of uneasiness that occurs on or about the anniversary of a significant event in our lives.

Today, Steve and I are profoundly aware of Anniversary Phenomenon. Last year, on February 18, Steve had a Living Donor Transplant, courtesy of his lovely niece Teresa. I remember doing what we thought was to be Steve's last Home Hemodialysis Treatment. I remember taking the ferry in the dark early morning to get to University Hospital. I remember the confident hope with which we signed the consent form. We were so excited; we were practically giddy.

After all, the odds of a successful transplant were extremely good--particulary with a healthy related living donor.

But, as we all know, there are no guarantees in medicine. Steve's blood pressure dropped to a systolic of 70 during the surgery; he had a run of bradycardia with a heart rate in the 30's. Ultimately, we were to learn that Steve had suffered a mild heart attack during the surgery.

Two more heart attacks and roughly five weeks later, Steve was still showing poor blood flow to the donor kidney. An interventional arteriogram was attempted. After that procedure, Steve began to bleed into his belly from the site of the disrupted anastomosis (connection). He went to surgery for the third time: this time for the explantation (removal) of the donor kidney.

There have been few nights in my life that have felt as bleak as that one. All of us - from Steve, to Teresa, to the Transplant Surgeons - were heartbroken.

For Steve, there was a protracted recovery: home with a "Wound Vac" packed into his open wound for a period of many weeks. It meant Home Dialysis through a central line again, as Steve's fistula had clotted off during his hypotensive episode. It meant a longer-than-expected absence from my medical practice; Steve was a heavy care post-op patient on Home Dialysis again. And it meant enormous financial sacrifice.

So, what happens next?

Next month, we are hopeful that Steve will pass his Nuclear Medicine heart study. But our optimism is cautious. He may need another stent; he could even require another CABG (Coronary Artery Bypass Graft.) .

But if he does pass the heart study, he'll be back in the ring again with other potential donors stepping up and many more hurdles to clear.

All I can say is this: Transplant is a modern miracle. But it doesn't always go as hoped. While we never expect to be the exception to the rule -- the one with the less fortunate outcome, it can happen.

My deepest respect goes to the man who says "For a kidney--with a fourteen year old daughter? I'd do it again in a minute!"

So, Anniversary Greetings to Steve and to Teresa. You are loved and treasured for your courage.

Take care. Linda Gromko, MD

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