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 71