Rejection is an inextricable part of transplantation. Whether signs of rejection appear in the first moments of transplantation, the first week, the first 30 days, or the first 3 months, rejection is almost guaranteed to happen. About the only time it doesn’t happen is when identical twins are donor and recipient. Identical twins = identical DNA. According to Derek’s surgeon–and he’s got lots of experience–high bilirubin when the patient says they feel fine typically means a mechanical issue. Bile isn’t flowing through the ducts, or blood flow is inhibited. Derek experienced a bit of this when he got my liver. He felt ok, but his bilirubin was indicative of the artery failing. This time, his bilirubin spiked but he felt like utter crap. Or as his surgeon said, he looked like a wet noodle. This usually means rejection.
Monday was a new day, Derek’s bilirubin dropped 4 points overnight after receiving IV steroids. His surgeons declined a liver biopsy because they could see with their eyes that his liver was functioning. We asked about cross match testing with cadaver transplantation. Turns out there’s not enough time, the test takes 6-8 hours and that is too long to wait for a liver transplant. Livers are like mayo based potato salad on a hot summer day; it’s best to not leave them out too long. They cross matched Derek and I because they had time. That might be why he’s experiencing symptoms of rejection. But it could just be his time to experience rejection. To paraphrase Derek’s surgeon: “I dropped a traumatized, but healthy liver into a hornets nest. There were bound to be some issues.”
There a 3 basic types of rejection:
- Hyperacute rejection
- Acute rejection
- Chronic rejection
Hyperacute rejection happens within moments of the patient receiving the organ and the only solution is removal of the tissue. This is typically the result of a blood type mismatch.
Acute rejection happens within the first week to first 3 months of transplant. All recipients experience some form of acute rejection. Derek sees this as a good sign, it means the immune system is doing what it was designed to do. The doctors then hack his body’s immune system to get it to chill out so it doesn’t keep trying to attack the foreign object.
Chronic rejection is when the body continually attacks the organ or tissue and succeeds in damaging the perceived interloper.
Bottom line: A 4 point drop in bilirubin is good, but it needs to keep dropping in order to get Derek out of the hospital.
If this Livernalia experience were a film, most of you would have walked out of the theatre by now. Too much drama, too much time spent in the bathroom, too many ups and downs, seriously, get to the end already! Sheesh. I know I would have walked out and chastised the filmmakers for a bloated script and probably wondered if the editor was trying to sabotage the film. Last week, the waiting period for a new liver was finally over; Derek got what he’d been waiting for. It should have been our little story’s denouement. You all whooped it up and cheered like a good audience should, and to overuse a tired metaphor, I kept my foot on the brake. I couldn’t let myself believe we were out of the woods because Derek, as we’ve all learned, is not a normal man. He breaks a lot of rules when it comes to typical transplant patients.
When I saw him the day after surgery in the PACU, I couldn’t believe my eyes. He looked tired, but normal. As normal as someone can look in a critical care unit. My foot eased off the brake just a little bit. A couple of days later, the bilirubin was back up and I jammed my foot on the brake, mentally gave the doctors the middle finger and cursed them for cutting me off. Sunday night I was truly pissed off. I did all the research, I knew rejection was going to happen, I knew there would be another plot twist, but I was still angry.
Derek’s transplant coordinator told us on Friday that when this transplant happened, we became permanently linked to everyone here at Lahey. If something were to happen to Derek that necessitated a trip to the emergency room at our local hospital, that hospital would stabilize him and then transport him down to Lahey. The Transplantation team is his team for the rest of his life. If we stop calling or showing up for appointments, they will hunt us down to check up on Derek. For the rest of my life, I will be aware that my husband is a transplant recipient. My concern, my hyperacute worry, will fade over time, but my foot will always hover over the brake.