Saving Tyrion Lannister - Transplant Day

After a long night of tossing and turning, thinking, worrying and praying desperately, I received the call I had been waiting for from Dr. Aronson, the transplant surgeon, saying it was go time.  A final type and cross match had been completed and Tyrion would receive his life saving kidney from a donor named "Fish".

Fish would go first.  At 8:30CST, Fish was being prepped for the transfer and his procedure would take around 2 hours.  Tyrion would be next. 

Tyrion's internal medicine doctor, Dr. Cleroux, called soon after and said that Tyrion was being readied for his part as well.  She reported that his hematocrit (the red part of the blood cell) was 34 - nearly normal!  As a reference point, when we first took him to Hillside in Dallas, it was 10, since then it has swung anywhere from 12-21.  She said he was feisty during his morning assessment and that he was in a good place; as ready as he was ever going to be for this.  We all agreed, it was now or never.  

Today was one of the longest days ever.  Instead of waiting anxiously for our daily call from the hospital, we didn't want the phone to ring until at least 4 or 5pm.  Anything earlier would mean complications, of which there were many potential ones.  I received an email from Dr. Cleroux around 4pm saying that everything was going well so far.  At 6pm, the call finally came from Dr. Aronson,  The transplant had been a success.

During the surgery, his left kidney was removed.  Sometimes both kidneys are left in place, which eventually just shrivel up and "die", but when a biopsy on the left side was obtained, the kidney started to "ooze" and bleed, so it was removed for that reason and for space.  

The only major complication during surgery was when Dr. Aronson attached the vessel of the kidney to the aorta, there was some leakage of blood from the suture/attachment site.  She added another stitch, it still leaked a bit, then added a mesh like patch, which seemed to resolve the issue.  This potentially creates one of the more worrisome scenarios for complication.  Tyrion was no stranger to clotting issues, as he had one exactly two weeks ago, where he was leaking blood from around his dialysis catheter site and his blood volume was dropping quickly.  This was corrected with a combination of therapy and never occurred again until today, mostly due to irregularities in his clotting abilities.  If this area begins to leak again, it would likely be fatal. 

So once again, we want time to pass with no phone calls until tomorrow morning.  A phone call means a problem.  

This day seemed like it would never come and I am still in a little bit of disbelief that it all went off without too many hitches.  Tyrion is far from out of the woods, but with each passing day, his odds improve.  He will spend the next few days in the ICU and will be very closely monitored.

Bringing him and "Fish" (who's new name shall remain top-secret for now) home together will only get closer and closer to happening in the coming days.  I'm sure those days will be filled with ups and downs and we will continue to wait each day for no phone calls. I can't wait to meet Tyrion's new brother, they already have a special bond.  Fish did beautifully during his part & will spend the night in the hospital, mostly just for observation as he had the easy part out of everyone today.  

To say this team of surgeons and medicine doctors at U Penn are incredibly skilled would be a gross understatement.  What they did today was nothing short of amazing.  Not because it was our cat, but because the odds were certainly not stacked in Tyrion's favor.  He is the smallest kitty (and maybe the youngest) to receive a kidney transplant.  His case was far from straight-forward or textbook leading up to today.  If it could go wrong, at some point it did.  We are still in the dark about what the cause of his kidney failure was, but a biopsy should be able to tell us in a week or two.  As Dr. Cleroux told us, Tyrion certainly made them think out of the box every step of the way.  I can't imagine how proud they must be that they all did this.  Tyrion not only ended up having our support systems behind him, but pretty much the entire hospital staff as well, as they had all taken such good care of him, sat with him during his 6-8 hours dialysis treatments or had slept in their arms.  I think it's safe to say they all love him, just as we do.

What I wouldn't give to be able to give that little kitty a snuggle and a kiss right now.

**Update:

At 4am this morning we got a call from the transplant surgeon stating that her concerns about internal bleeding were beginning to present.  Tyrion's blood pressure had dropped and he was not looking well.  A radiologist was called in and verified that he had some blood pooling in his abdomen, although it was impossible to know what was causing it.  Our only choice to save Tyrion was to send him back to the OR to see if this could be fixed.  While we were putting his tiny body through yet another major operation, with no guarantees, we felt that the entire process, including the receipt of this fresh new kidney, would have been in vain had we not proceeded.

Around 9am, Dr. Aronson called and said that they did it; they had saved him once again.  The bleeding was not coming from where we had all feared (where the organ met the aorta or vena cava), but from a microscopic surgical suture - not even visible to the human eye without a microscope.  Since Tyrion's clotting factors were not back to normal yet, for some reason he was bleeding from that teeny, tiny, pin point area.  I think it is amazing that she could even find where the bleed was coming from, let alone remedy it.

So another pothole in the road, detoured.  Tyrion...you are giving your mom and dad daily heart attacks. Please stop.

We will be updated again this afternoon, baring any further complications.  I am holding a constant prayer vigil in my head, day and night.  

Tyrion - Pre-Transplant Day