The Culture of Different MKTG_150064494_2018 Service Line Big Book Full_FIN | Page 72

For Adrian to Live, His Immune System had to Die
Nephrology • Urology • Immunology • Transplant Surgery
part of herself, too — it made
sense. She felt, again, that sense
of providence: “This is where I’m
supposed to be. This is what I’m
supposed to do.”
Wiping the
immunological slate
Cross-matching combines an
intended transplant recipient’s
blood with an intended donor’s
blood to see how the recipient’s
antibodies will react. For
the transplant to work, the
crossmatch must be negative.
Adrian and Jaime’s crossmatch
was positive.
“But in the 21st century, a
positive crossmatch can be
quantified,” says Dr. Goebel.
“It might be close enough to
make it work.”
An intended donor and
recipient’s blood is combined
in the lab to test how the
recipient’s antigens will
react. Without a negative
crossmatch, the recipient
will reject the organ. For
Adrian, a naturally negative
crossmatch would not be
possible.
For last-hope cases like
Adrian’s, Drs. Goebel and Bock
were working to refine a rarely
used, somewhat controversial
process called desensitization.
The process acclimates a
recipient’s system to a donor’s
tissue, essentially by killing
off the antibodies that would
attack it. The first step is to
filter them out of the blood by
plasmapheresis.
“So the question is, how many
plasmapheresis sessions do
you need to get a negative
crossmatch?” says Dr. Bock.
“Normally you’d do about five to
eight of them. We came up with
eight. We were nervous.”
“They flat-out told me, ‘This
might not work,” recalls Jaime.
“I think that made me want to
do it even more.” on ice and walked it down the block to Children’s
Colorado, where Adrian was ready for it.
Knowing Adrian’s antibody
production would naturally
ramp up as they filtered them
out, Drs. Goebel and Bock
finished the job with a leukemia
drug called alemtuzumab,
which binds to and kills
lymphocytes, temporarily
wiping out Adrian’s immune
system. In the short term,
it would put him at high risk
for infection. But with an
immunological clean slate, they
hoped, Adrian’s system would
rebuild and possibly even come
to recognize the foreign kidney
as its own. “I think the fact that a donor could come to a
hospital, and that hospital could identify a person
in need at a different hospital says a huge amount
about our relationship with Children’s Colorado,”
says Alex Wiseman, MD, Medical Director of the
Kidney Transplant Program at UCH, who oversaw
Jaime’s medical evaluation. “The enthusiasm to
make it successful was impressive.”
“It was either that or nothing,”
says Dr. Bock.
The effort required a huge
team. They worked with adult
nephrologists, pathologists,
hematologists, immunologists,
anesthesiologists and
surgeons at UCH, as well as a
corresponding pediatric team
at Children’s Colorado. They
worked with cardiologists,
urologists, neurologists. Dr. Bock
speculates about a hundred
specialists were involved.
“That Friday before the
transplant, we got the
first test back that was
completely clean, showing no
antibodies,” Dr. Goebel recalls.
“That was one of the highlights
of my career.”
The next Wednesday, UCH
surgeon Trevor Nydam, MD,
took out Jaime’s left kidney. Dr.
Nydam’s team flushed it, put it
Michael Wachs, MD, Surgical Director of the Liver
and Kidney Transplant Program at Children’s
Colorado, performed Adrian’s operation. Within a
minute of connecting the blood supply, the limp,
white organ pulsed red and spurted urine.
Again, Dr. Wilcox assisted. His job would be
difficult. Because Adrian’s 14-year-old bladder had
essentially never been used, it held about 20mL
of urine. A healthy bladder holds about 300. The
muscle had become brittle and thick, and suturing
it to the ureter would require a delica te hand. Dr.
Wilcox didn’t know going in what the Mitrofanoff
he’d constructed 10 years earlier would look like.
“Amazingly, it was still fine,” he says. “In fact, just
recently we’ve taken the catheter out so that,
during the day, he’s urinating as normal.”
For a 14-year-old boy who has essentially never
urinated, that’s an incredible success.
A run at a new life
The day after Adrian’s operation, Dr. Goebel walked
over to thank Jaime, who was at UCH recovering.
She didn’t know to whom her kidney had gone,
and Adrian didn’t know whom his kidney had come
from. But he wanted to meet her. She wanted to
meet him too.
Because of patient privacy safeguards, it took
a couple of weeks to arrange the meeting. Dr.
Goebel stayed in touch. He told Jaime about
Adrian: He’d never attended school full-time. He’d
never even eaten chocolate. And while the damage
of years of dialysis had been halted, it would not
easily be undone. He would face tough challenges
— educational ones among them. Dr. Goebel knew
that was Jaime’s area of expertise.
“He asked me, ‘How do you feel about being more
involved?’” she recalls. “I just started crying. I said,
‘You don’t understand how important this is to me.
Yes, I’m in. I’m all the way in.’”
She met Adrian and Alicia a week later, and they
immediately hit it off. Jaime and Alicia talked
nonstop for more than two hours. Adrian was a
little more reserved at first, but he eventually
opened up. She gave him a Chromebook to help
with his schoolwork.
“He actually texted me the other night,” she says.
“They flat-out told me, ‘This might
not work.’ I think that made me
want to do it even more.”
JA I M E B A I L E Y
Adrian’s donor
“He’s doing incredibly well — he’s talking about
wanting to move into a harder algebra class, which
floors me.”
As a high school freshman, Adrian is attending
full-time school for the first time. He has an
educational plan, and he, Alicia and Jaime meet
with his assistant principal and school nurse to
assess his progress once a month. He plays soccer.
He’s made lots of friends.
“I have so much energy,” he says. “I feel great
every day.”
“That’s what he told one of the nurse coordinators
right after he came out of surgery: ‘I feel so good,
I feel like going for a run,’” Dr. Bock recalls. She
laughs. “He’d probably never gone for a run in his
entire life.”
The Culture of Different
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