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Thursday, July 29, 2010

Early Rejection?

Acute rejection is when the immune system of the recipient attempts to attack the donor organ as a defense mechanism. It is the body's natural way to prevent a foreign object in the body, by building up an army of antibodies to attack the intruder. A transplant recipient is placed on immunosupressant medications to trick the immune system into not fighting off foreign objects. This is why transplanted patients avoid germs, because not only does the immune system not fight off the organ, it cannot fight off anything else including infection, viruses or bacteria. Rejection is in its highest risk in the first 1 to 3 months post transplant, continuing on thru the first year. But rejection can happen anytime in following years, and a patient is never in the clear for the risk of rejection. Rejection can be caused by not taking your medications properly, your medication levels being too low to adequately trick the immune system or by the body building a stronger army of antibodies or even a new cellular mediated immune system (CMI) to attack the organ. Rejection is found through a series of clinical symptoms, and confirmed by taking tissue samples of the organ and testing them. Rejection can be treated, and the sooner the better. In early stages, it can be treated by something as simple as a steroid. In slightly advanced cases, by short term IV therapy or even a 3 step IV treatment. The worse the rejection, the harder to treat. And every episode of rejection slightly contributes to stressing the heart out over long term.

So why am I being Wiki-Kristi-A? Not because I feel super guilty for not updating my blog enough, but because we may be facing our first episode of rejection. Gabriella is 10½ weeks post-transplant right now. Her first biopsy just one week post-transplant was a big ZERO, and again at 1 month. Gabriella has been complaining of a sore belly for a few days, along with having a decreased appetite and what we found today to be weight loss. I mentioned this at clinic, but it wasn't until the clinic doctor spent (spent way too long) listening to her heart that it became relevant. In a person with their native heart, they feel heart pain in their shoulder or arm or neck, but in a transplanted patient, their nerves have been severed and have been found to feel that pain in their abdomen. Determining when it is just too many cookies in a 5 year old, or issues with the heart, is difficult, but today the doctor paired it with a gallup sound in her heart- another clinical sign of rejection. There are too many clinical symptoms put together, leading us to consider rejection as the cause.

SO the amazing transplant team that we have (how will we EVER leave them????) got us in for a stat biopsy TOMORROW. That is the true answer to whether or not she is in rejection, and to what degree, giving us a better idea how to treat it. Biopsies are risky in their own right, which is why Loma Linda does not do routine biopsies as frequently as other hospitals. There is risk for injuring heart tissue or valves, risk with the sedation, risk for bleeding and *ahem*stroke*ahem* (we all know how much I love the risk of stroke......). But this is non routine and vital, so we will have this biopsy tomorrow and PRAY for the results.

- I have never had to explain how they rate rejection because ZERO is the one time you can be happy about the goose egg. (Because it is NEVER a good thing when your bank account is a ZERO, or your gas tank, or your bottle of cooking oil when you are in the middle of making cookies). We haven't had to worry about a 1A or 2R.... but rejection is ranked on a scale from 0 to 4, having 2 severities to each grade. -

Gabriella's cyclosporine (immunosuppressant) levels were also low, but they do not feel that is a contributing factor to the possible rejection. Her white blood cells are low again, and her CellCept (the other immunosuppressant) has been stopped for a week to get them back up. This seems to be a trend for this medication, and it is a hard medication to maintain a dose on.... you pretty much have to go off of it for a week and let the cells build back up before you start it again at a lower dose and wait a week for them to get into a therapeutic range.

So, thats the deal. I am treating this rejection as an "innocent until proven guilty" case. Once we have the biopsy results, I will be able to share the verdict and sentencing with all of you. Regardless, it's presence is unwelcome and came into the wrong momma's baby. I won't stand for it, and will protect this precious sparkly heart if its the last thing I do.


Corey~living and loving said...

you know I'm praying! ♥

Michelle said...

We stand behind in you in protecting her precious sparkly heart.

Callie said...

I'm praying for Gabriella and you that what you are seeing is NOT rejection. I found your blog through Funky Heart's blog and started following your story when Gabriella received her heart and have been celebrating her recovery from afar. As a mother of a little heart boy I know all too well the roller coaster. I will keep you all in my prayers.

Beth @ Snaps Of Our Life said...

I'm praying for you all!

Danielle said...

Praying for you and Princess G!

The Simmons Family said...

I just wanted to say that we are praying for Gabriella's sparkly heart to be perfectly fine!

The Hopeful Elephant said...

Always Praying Kristi.

Will watch all day. Big hugs to you all!

Unknown said...

Praying, Kristi, for a Big Fat Zero for Gabriella.

Mary Ellen said...

Praying for y'all.

Mary Ellen