One Week To Surgery: Appointments and Hiccups

     Tomorrow will be one week until the transplant.

     A week ago I had my pre-surgery blood/urine testing and some of the blood was taken to redo our crossmatch testing for confirmation. They took 11 vials of blood and I had to provide a urine sample.

     Yesterday, my fiancé, Robert received a call from his coordinator, asking us to drive the 5 hours to the city for an appointment with a nephrologist early the following morning. This last minute appointment was to discuss something that they had discovered during our final cross matching. His coordinator did not give us much information about it but said:

“We have discovered that it is not as close of a match as we would like it to be.”

     Luckily, my coordinator called shortly after and wanted to provide a little more information on the matter. She told me that our previous crossmatching was good but that they did more extensive testing this time and discovered that Robert has an antibody against me. She didn’t get too far into things, but said that we would be given 3 choices:

1) Continue with surgery as planned, knowing that the transplant would be a higher risk than we previously thought.

2) Sign up for the “Paired Donation Program”; where recipients and donors that don’t match 100% are put into a database. They then would look for a donor who matches Robert, that has a recipient that I would match and the recipients would swap donors. Essentially like musical kidneys.

3) Get put back on the transplant list and wait for a deceased donor.

     We had the meeting this morning with a nephrologist and Roberts Transplant Coordinator.

     They explained that Robert at one point was positive for an antibody, known as BW4, BUT he is currently negative for it.

     All of our current crossmatching is good but they went back and crossmatched my blood with his monthly samples of blood, going way back to February 2016 when he initially took sick.

     In March of 2016, Robert received 3 blood transfusions, due to losing blood in complications when doing his Plasmapheresis treatments. It was a blood sample from March 2016 (right after he received the 3 transfusions) that he had this antibody; just the one sample. 

     Not presently having the antibody is a good thing and it means that, if we were to procede with the transplant, we wouldnt have to postpone to do treatments (such as: IVIG or Plasmapheresis) to suppress kill off the antibodies prior to surgery. These treatments are not necessary at this time; but are possible in the future if his body were to begin to create the antibody again and/or his body attempts to reject the kidney.

     Due to this, the surgeon still wants to go ahead and we decided to as well. They will have to start him off on higher doses of immunosuppressive medications immediately following the transplant.
     According to the “3 Year Success Rate” chart that the nephrologist showed us that, by proceeding with the transplant: 

-he poses more of a risk of losing the kidney within 3 years than a perfectly matched living donation. 

-he would have an equal or slightly higher success rate than getting a kidney from a deceased donor.

-he would have a much higher success rate than a recipient that has CURRENT, active antibodies against their donor.
     One surgeon will be doing both mine and Robert’s surgeries and, not only is he comfortable doing the surgery with the slightly higher rejection risk, but the transplant center is quite experienced in doing them and they have a treatment plan ready for him for post-transplant.

     Robert will be admitted to the hospital the day before Surgery, while I will have my pre-surgery appointment and bloodwork to register me for the National Bloodbank (in the rare case that I would need a blood transfusion during sugery); this is a normal surgical procedure. I will not be admitted to the hospital until the day of surgery and they figure that I will be brought in to the operating room around 7:30AM. 

     My surgery will last 2-3 hours and it will be traditional, open surgery (see photo below of where my incision will be).

     I will be out of surgery between 9:30 and 10:30AM. They will immediately clean the same operating room and Robert will be brought in. His surgery will last 4-6 hours, depending on how quickly he can get out of the Recovery Room afterwards.

     Nerves have definitely begun to set in for Robert, as his mother and sister flew out here last week to be here for the big day. Between their anticipated arrival, and pre-surgery appointments coming and going, the date is quickly approaching now and everything is becoming quite real to him. 

     I am still not scared or overly nervous myself but we will see if that changes in the next 7 days..


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