Your blood is made up of red and white cells and platelets (don't ask me what they are) these are are all carried around in this fluid called plasma. The plasma can be separated from your blood, removed and replaced. This is called Plasma exchange. Your plasma can only be replaced with either fresh donor plasma or human albumin solution, which is the liquid part of the plasma obtained by processing the fresh plasma.
The function of plasma is to carry blood cells, (the red & white cells and platelets) and various antibodies, proteins etc, etc around your body. Plasma exchange is usually carried out when there is a problem caused by abnormal anti bodies or proteins in your plasma. Which was kind of the case here, as we were having an ABO incompatible transplant. Meaning my brother and I aren't a blood match, so they needed to bring his anti body count down to make the incompatible transplant more viable. As antibodies, which normally help to protect you from infection, can and will attack your own or foreign cells. Which is obviously a bad thing.
So they hooked my brother up to this big machine called a Blood Cell Separator. This machine separates the blood into it's various parts. It sperarates and removes the plasma portion of your blood and gives you back replacement plasma. The remaining parts of your blood including the red and white cells are returned to you during the treatment. This process takes 2-3 hours!!
So, the next day, K-day! The doctors took blood samples from my brother, to make sure the plasma exchnage had worked as intended. It hadn't, it messed up his levels, so he then had to have a blood transfusion via a drip, to try and even things out. This made his potassium levels too high, which is bad. So then he had to go on Dialysis for 2 hours to bring the potassium down. This was what caused the hold up in the surgery time.
My brother went down to surgery about an hour after me, i think. The timings of everything are still bit of an unknown, as it was all too emotional to be watching the clock. He had the same procedure as me pretty much, in the anesthesia room. His surgeon Nazim Mamode, came to see him just before, to make sure my brother was ok. My brother said, "I'm good, just dont kill me!"
As mentioned in my previous blog, My brother was back on the ward, after a few more tests at about. 12:45am.
My brother had the same things as me, he had a catheter in his winky (hehe), a wound drain, a massive bag of IV fluid and an IV drug clicker thingy, although he had Fentanyl in his, not morphine, as morphine is bad for renal patients. If you at all squemish, don't look at the next pic.... Look at this for a wound.
It's important to keep the new kidney well hydrated so my brother was tasked with the job of drinking 3 litres of fluid per day!! Way more than the recommended daily allowance of 8 glasses!! By the third day, he was starting to show some mild symptoms of rejection. His creatinine had gone up from 200 post transplant to 235.
Creatinine, is a natural waste product from the kidney, it's an indicator of how well the kidney is functioning. In a healthy person, your creatinine level in anything between 60 and 110. So, pre-transplant he was at something like 400!! The Doctors began a process of elimination, for the rise in his creatiinine level. The first was to check how hydrated he was as dehydration can cause a rise in the levels, this was fine. Next up was a scan, to see if the cause could be surgical. Had the kidney been plumbed in correctly was there a surgical issue. Nope, that was fine too. They tested his levels again and they had gone up to 253. Not a good sign at all. I was now getting very edgy! The one aspect of this whole thing that I had been dreading, looked like it could be happening. I'm not gonna lie, it was tough for me to stay positive.
The next step was a kidney biopsy! Where they basically fired a gun with a needle on it, directly into his wound and into MY kidney, to take a small piece of the tissue. They did this 6 times!! He then had to lie flat and very still for about 6 hours, to avoid rupturing his new kidney.
The biopsy revealed that there was some rejection happening, so he was put on a 3 day course of strong steroids and given a lot of fluid. 5 litres a day to be exact. His weight went up from 93.9kg to over 102kgs in just 3 days!!
He was finally discharged on the 22nd Feb. Where it would seem he has gone from strength to strength. He was supposed to visit Guy's 3 times a week for the next 2 months, but they are so happy with his progress, he only has to go twice a week now. His creatinine level is 151 and the kidney, Lucy, that I gave him, was functioning at 46% in my body and it is functioning at 44% in him!! Good ole Lucy!! I knew I had good organs!!
This isn't the end of the tale though, he still has a way to go, the next 2 months are important. However, if he keeps going the way he is, everything should be just fine.
He just sent me a picture of his wound as it is now, some 3+ weeks later........
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