Tuesday, April 3, 2012

Kidney transplant patients meet their matches

When John Marzelli learned he had a serious kidney disorder, IgA nephropathy, and would require a transplant, his sister, Tracy Marzelli, agreed to become his donor. Fortunately, his sister’s blood type made her a match to donate a kidney to him. The surgery was scheduled to take place at Mass General late last year.

IgA antibodies had built up in John’s kidney tissue, causing serious damage. During the months leading up to the transplant, he also developed an antibody that would prevent him from accepting his sister’s kidney.   

The news was disheartening. John was already relying upon daily peritoneal dialysis, an onerous procedure that cleans the blood, to compensate for his failing kidneys.

Undaunted, the Marzellis discovered new hope. Kidney Paired Donations (KPDs) pair willing living donors with recipients in a donor chain. National kidney registries exist for this purpose, but Mass General also has its own internal exchange program.

“The national registry can take many months and the patients face a lot of variables,” says Transplant Nurse Coordinator Anne Seaward-Hersh, RN. The internal match process involves less uncertainty and can happen more quickly.

During one of the Transplant Center’s weekly case conference, the multidisciplinary team determined that there was another donor/recipient pair who were also incompatible with each other but would be a match for John and Tracy.

Tracy remembers it was the day of her company’s Christmas party when Seaward-Hersh called with the news.

“It was a great way to celebrate the day,” Tracy says. “We were pretty excited.”

John Marzelli, Esperanza Yoblonsky, Evangeline Guevarra and Tracy Marzelli
From left to right: John Marzelli, Esperanza Yoblonsky, Evangeline Guevarra and Tracy Marzelli.

Perfect Match

Like John, Esperanza Yoblonsky was suffering from IgA nephropathy. First diagnosed with IgA nephropathy at a local hospital in 2006, Esperanza’s condition wasn’t improving.

“A lot of people had been telling me, ‘Just to go to Boston, to Mass General,’” she says.

Her first day at Mass General, Esperanza underwent a series of tests. “In one day they did what they did in four years” at her local hospital, she says. “They told me my kidneys were so bad that I need dialysis right away.”

Esperanza returned to her home country, the Philippines, where her six siblings tested to see if they would be a match for a kidney transplant. They were not, but Esperanza’s sister Evangeline Guevarra was coming to the U.S. for a wedding and, while she knew her sister was not a match, Esperanza hoped the two could take part in a study for an ABO-incompatible transplant or find another pair for an exchange while Evangeline was in the country.

The sisters found their match in Tracy and John Marzelli. As the Transplant Center team noted, Evangeline was a match for John, and Tracy for Esperanza.

In the weeks before the surgery, Esperanza relied upon her transplant nurse coordinator, Lorela Bautista Hess, RN. “She helped me a lot because I never stopped calling her every day,” Esperanza says. “They’re very professional and thorough of what they’re doing and they listen to you, and they’re so helpful,” she adds of Mass General staff.

Evangeline underwent testing to ensure that her kidney would be adequate for John, who is at least a foot taller. 

“It just flowed together,” Seaward-Hersh remembers.

Successful Surgery

The siblings with Transplant Nurse Coordinators Lorela Bautista Hess, RN (left), and Anne Seaward-Hersh, RN
The donor-recipient pairs with Transplant Nurse Coordinators Lorela Bautista Hess, RN (left), and Anne Seaward-Hersh, RN.

Six weeks after they were identified as a match, the pairs underwent surgery at Mass General. Surgical Director of Mass General’s Dialysis Access Program, Tatsuo Kawai, MD, PhD, removed Evangeline’s kidney, and Surgical Director of Kidney Transplantation, Dicken Ko, MD, transplanted it into John Marzelli. Chief of the Transplant Division, James Markmann, MD, PhD, removed Tracy Marzelli’s kidney and Nahel Elias, MD, transplanted it into Esperanza Yoblonsky.

“It’s the most blessed; it was a very successful surgery,” Esperanza says. She extended her thanks to her sister and their multidisciplinary teams, including Hess and Seaward-Hersh, “who put all this together. And found us a loving swap!”

“Everybody was great-- the nurses were unbelievable. The food was good, too,” John says, adding: “From the beginning everybody’s so attentive to your needs; they really take good care of you here.” 

Kidney donors typically require less recovery time than recipients and leave the hospital a couple of days after surgery; Evangeline and Tracy were no exception.

“I felt like I studied and aced a test,” Tracy says. “Two weeks later I was back at work. I felt really good.”

Donor Evangeline, agreed: “I feel good, like nothing happened.”

The pairs met in the hospital hallway after their surgeries and became fast friends, inviting each other for walks in the hallway during recovery.

Just a month after their surgeries, they sat together at the transplant clinic, chatting like old friends, planning barbeques in the coming months and sharing Facebook photos of themselves together in the hospital.

“Going through the swap program, we get to solve our problems and someone else’s,” Tracy says. “I wish I had more kidneys to give.”

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