Friday, January 26, 2007

Transplant News

On Thursday of last week (1.18.07), Stacy and I took Julian to visit Dr. Ford at The Children’s Hospital (TCH) in Denver. Dr. Ford, Julian’s Nephrologist (kidney Dr.) had requested we come in a month early, so we were a little apprehensive. As the discussion began, our expectations were confirmed: Dr. Ford wanted Julian to go on dialysis.

Since last October, Julian’s kidney performance has been dancing around a threshold that traditionally triggers the need a for kidney transplant or, in the event that he’s not yet big enough for a transplant, dialysis. Stacy and I were hoping that Julian would be big enough for the transplant. According to Dr. Ford, this was probably not so.

Here’s why. A young kidney transplant patient can receive a new organ in one of two places: the pelvis, or the peritoneum (the smooth transparent membrane that lines the abdomen and doubles back over the surfaces of the internal organs to form a continuous sac). Traditionally, patients 15kg or above can usually receive a kidney in the pelvis (the old kidneys are left intact). However, patients weighing between 10kg and 15kg are usually considered too small to receive the pelvic transplant, and must receive it in the peritoneum. This becomes a problem in the event that the patient needs to be dialyzed in the future, as not all patients qualify for hemo-dialysis (when the blood is removed, cleansed and replaced mechanically through a port into a vein). The only other option is peritoneal dialysis, which would not be possible if there were already a transplanted kidney in the peritoneum. In that this would restrict Julian’s possible modes of treatment, it looked like we were headed the dialysis route. Julian is just below 10kg at present.

However, Dr. Ford encouraged us to meet with Dr. Koyle (Julian’s Urologist) and Dr. Karrere (TCH’s head transplant surgeon), to get their input as well. Our meeting with Dr. Koyle took place on Wednesday morning (1.24.07).

By the time we met with Dr. Koyle, he had already read Dr. Ford’s report of our meeting the week before. It turns out Dr. Koyle and Dr. Karrer have written papers and performed pelvic kidney transplants on patients below 15kg. According to Dr. Koyle, their smallest patient to date was approx. 9kg. Further, Dr. Koyle thinks Julian is a good candidate for the procedure.

So, this Monday (1.29.07), we’re meeting with Dr. Karrer, Dr. Koyle, and the transplant coordinator to discuss the general game plan that they have already come up with. Dr. Koyle anticipates that the transplant could take place as early as this spring, depending primarily on the availability of a viable organ. Three months after that, he thinks Julian’s bladder will be ready for reconstruction.

Stacy and I are excited! We had hoped that we would be able to avoid dialysis, only because it’s one more invasive procedure (an ongoing one at that) that Julian’s little body would have to recover from. He’ll have to weather enough already, even without dialysis.

Please check back next week to see how things went at the Dr.’s. And pray with us for Julian’s health. Every night at dinner, we hold hands, give thanks for our meal, and pray that God would grow Julian up big and strong.