I visited my nephrologist yesterday. Apart from the regular discussion, I discussed the transplant and the immunosuppression. I told him about the call and that we needed to be ready this time around.
There are a lot of issues associated with my transplant. First of all, the association of Calcineurin Inhibitors like Cyclosporin and Tacrolimus with recurrence of HUS. There was a research paper I found on the internet from the Mario Negri Institute in Bergamo, Italy, an institute that has been doing a lot of work on HUS.
The paper said, "On the basis of these data, renal transplant should be considered an effective and safe treatment of ESRD for patients with STX-associated HUS, but considered with extreme caution in patients with non-STX forms."
Obviously I have the non-STX form. Life has to be exciting, right?
So, for me, a transplant should be considered with 'extreme caution'.
Another complication is my WBC count. It has been consistently low. Which hampers my ability to fight infection. And infection is a big risk when I will be on immunosuppression.
Now, I also have an enlarged spleen. My nephrologist felt that there was a possibility that some parts of my blood were getting sequestered in my spleen and this could be a cause of the low WBC count. So, he thinks we should consider the possibility of doing a splenectomy (remove the spleen) before going for a transplant. But he's not sure.
The spleen by itself has a big role to play in the immune system that helps fight infection. So, if you remove the spleen you are again reducing the ability to fight infection.
So, all these things need to be considered. And then there is the dragon too. Which makes the whole equation more fun.
We are however pretty much decided on the immunosuppression. We've pretty much decided on using Sirolimus, MMF and Prednisolone.
My nephrologist is however not sure about the course to take with respect to the spleen.
To conclude, yesterday he said we should go ahead with the transplant (after taking a decision and possibly some action on the spleen). But he warned, we should be fully prepared for rejection or recurrence of HUS. And then not take any "over enthusiastic" steps in case there was a sign of losing the kidney. Basically give up without too much of a fight because it would increase the risk of other complications.
Which is not a whole lot encouraging.
I am now going to go and meet Dr. V.S. Reddy, the nephrologist at the center where I will be undergoing the transplant to discuss this.
Let's see what he has to say.