Last week’s kidney biopsy revealed that Lanna was experiencing both types of rejection, acute and chronic. The doctors have gotten the acute rejection (lesser of the two) under control via steroids, and they are working to reverse the chronic rejection.
This means that Lanna’s body has developed antibodies against the kidney. A level of 250,000 antibodies indicates enough present to cause concern — Lanna’s level is at 400,000.
She is on her second round of plasmapheresis, which is a process similar to dialysis in which her blood is cycled through a catheter, only it is targeted at removing plasma from her blood. The plasma is what carries the antibodies. In between each treatment of plasmapheresis, Lanna is intravenously receiving a drug (rituxan, I think) that specifically targets the antibodies by binding with and dissolving them. The treatment consists of 4 times alternating between plasmaphereis and the drug. She had received this treatment last week with a different drug, which seemed to work well but didn’t quite decrease her antibodies enough. Her doctors then put her on an experimental drug, IVIG, that only succeeded in raising her blood pressure and raising her creatinine level (it had gone down to 2.5, but now it’s back up to 3.1 where it is holding steady), making her doctors stop that drug and decide that a second round of plasmapheresis was necessary.
The puzzling thing is that Lanna is not showing any other signs of rejection. She is still urinating and the kidney is working to remove excess fluid, so it hasn’t stopped its functions. She has started to retain some fluid, but it seems to be mostly in areas where she has an IV or catheter. Her blood work is also pretty stable right now, which generally would get out of balance with rejection, not to mention the treatments she’s receiving.
Emotionally, Lanna is faring well. She was fairly distraught when she was first admitted into the hospital, but now she’s handling treatments more calmly, even though the current treatment saps most of her energy.
Thus the waiting game continues. We don’t know what’s in store for Lanna, but this much we do know — many things have worked out so far to show God’s intervention regarding this transplant and its timing. To recall a few:
– Lanna was in a mindset to receive a transplant, had gotten all of her required tests up to date, had even mentioned something to her boss about needing time off if she did get a transplant because a friend had offered to get tested to give Lanna a kidney (that didn’t work out, but a few days after the friend’s test came back negative, Lanna got the call about this kidney).
– just 3 days before she got called, we’d had our church-wide fast.
– it occurred after cold & flu season, decreasing her potential exposure to disease.
– her dialysis was no longer functioning well, so she was at the point of needing something to change drastically regarding her health.
– the transplant itself only took 3 hours, with no complications, although the doctors were concerned about the amount of scar tissue she has.
– her bladder has adapted amazingly after 8 years of no use, and it can now hold almost a normal capacity and continues to do its job.
– her blood pressure has steadily been at a very healthy 117/70, where before it was usually at 60/40, and most transplant patients have problems with high blood pressure.
These are just a few of the reasons to believe that God is very much involved in Lanna’s health right now. There are so many of you praying, too, that I don’t doubt He is listening and will intervene again on Lanna’s behalf.
In Christian love,
Update on Lanna #9 (7/9/09) July 9, 2009