As most of you know, I went in for another kidney transplant on May 20th, 2025. The day before my surgery I wrapped up my final dialysis session, tossed out my ragged dialysis blanket and pillow, and made the trek down the mountain towards Duke University Hospital.
I spent the evening with my wife and parents, and did all the necessary prep before the big day. From my experience last year I knew that one of the most needlessly painful parts of the entire experience would be having patches of hair ripped from various parts of my body, so I put in the effort of shaving everything from the waist up. This proved to be an extremely worthwhile effort. I had one last pre-transplant meal with the family, then it was off to bed and off of food and drink.
The following day I reported at the time I was assigned, but ended up sitting in the waiting room for around four hours until I was finally called into the prep area.
The vibes of this transplant were quite a bit different from the first (unsuccessful) one. The stakes were even higher than before, but at the same time, I had come to experience more of the kidney failure lifestyle, which I knew would make the positive outcome all the more rewarding.
As they brought me into the operating room, I saw my surgeon standing over a metal bowl. “Want to see your new kidney?” she asked. “Of course!” There, I got to peer inside and see my new kidney, much larger and healthy looking than I expected, just waiting to be installed. As they splayed me out on the operating table and began to administer anesthesia I could see the surgeon continuing to give a pep talk to the kidney. No pressure, little dude.
I woke up groggy, but the surgery had gone well. Through the course of the next few hours a familiar series of events began to play out, although the urgency was different this time. There was some suspicion that something wasn’t quite right, followed by an ultrasound. This time, however, I was lucky. Instead of a blood cut going into the kidney and cutting off the supply of blood to it, there was just a small clot blocking the output going into the bladder. They scheduled me for a non-emergent surgery that afternoon, cut out the blood clot, and immediately, the new kidney began to start working tirelessly.
I spent the next five or so days in the hospital resting up and regaining enough strength to be able to get out of bed again. Eventually I had enough strength to be able to walk around the hospital wing, and even climb a few steps unaided. With that, they removed the central venous catheter in my chest that I had used for dialysis, and discharged me so I could continue healing at home.
I was tremendously swollen around my midsection, which continued to get worse. After three days at home I could tell things weren’t right, so I went to the local emergency room, where they then sent me (by ambulance, twelve hours later) back to Duke. I would spend an additional 8 days there receiving treatments and tests.
My creatinine, which measures the amount of waste product in my blood, had climbed since first leaving the hospital. This was an indication that something wasn’t working as it should be with the new kidney. By this point, we knew I had a hematoma around the transplanted kidney, but it wasn’t clear whether or not that was the cause of the issues. If the hematoma puts pressure on the kidney it can prevent it from filtering the blood correctly, but the ultrasounds and other imaging made it seem that this was not necessarily the case.
The best thing to do would be to have a kidney biopsy of my new kidney, but the hematoma made this dangerous, so it was decided that the safest approach would be to proceed without a definitive diagnosis and treat for the symptoms themselves. A blood test confirmed I had not built up any new antibodies against the kidney, but there is a second type of rejection, a cellular rejection, which my condition very closely resembled. They placed a PICC line in my arm so I could receive an advanced treatment to combat this rejection. This treatment, called Thymoglobulin, is administered over the course of four days, six hours at a time. Before you start each treatment you take a mixture of Tylenol, Benedryl, and IV steroids (on top of the dozens of other pills I am already on), and then the treatment works to further suppress the immune system beyond the anti-rejection medicines and the medicines they give you prior to your transplant in the operating room. Once everything is done, your lymphocyte count is down to zero, and the rejection episode is (hopefully) over.
I struggled a bit with the Thymo infusions at first (they made it difficult to breathe, and gave me a horrible headache), but after the first treatment I handled it much better. Along the way there were some stumbles (including an incident where a medication re-triggered my atrial fibrillation), but ultimately everything did its job, and my creatinine returned to nice, low numbers.
I am once again back out of the hospital, and am working on building strength every day. My kidney appears to be working incredibly well, and I continue to monitor both blood levels and overall output on a daily basis. I still have to return to Duke one day per week for the time being, but this transplant has gone much, much better than the last one, and I am on the road to a semi-normal life again.
Thanks again to Micah for donating his kidney, and huge thanks as well to the dozens of doctors, nurses, and other staff who have looked after me over the past month.