Philadelphia Inquirer - Children's Hospital of Philadelphia - 14

www.philly.com THE PHILADELPHIA INQUIRER Monday, October 1, 2007 Allison wanted it over. She was unsettled by what she knew of C-sections and scared that she might get sick or pass out. She prayed that the baby would be healthy. Her mother squeezed her hand. She would stay with her. At 1:50 p.m., Adam Kamel Kadi was delivered. Nadia’s brother weighed in at 8 pounds, 3 ounces and was 21 inches long. A nurse commented on how much brown hair he had. The pediatrician walked over to Allison. Congratulations, he said, he looks great. Adam was healthy. Allison wanted to see him. The nurse brought the baby over to his mother. He was beautiful. And then he was gone, off to the nursery while the obstetrician finished up with Allison. Back in her room, Allison refocused on Nadia. She was worried. She knew the first couple of days after a transplant were the most dangerous. Would her little girl be OK? Would Nadia’s body accept the new liver? Would she get a blood clot? The artery ‘danced’ At CHOP, Shaked and Olthoff began the last movement in the wellchoreographed surgical ballet. They stitched the new liver to Nadia’s arteries and veins. At 3:28 p.m., the surgeons released the clamps holding back the blood flow and held their breaths. Nadia’s new liver began producing bile. The main artery feeding the liver pulsed with blood. Free in the girl’s abdomen, the artery “danced.” Shaked and Olthoff relaxed; the dancing artery was the positive sign they looked for in every transplant. Blood was again flowing to the liver. The organ had been without blood for nearly 81/2 hours. As the surgeons began to connect the bile duct from Nadia’s new liver to her small intestine, Rand went out to the waiting room to deliver her update. Joe was ecstatic. Together, he and Rand called Allison, passing on the good news. In the operating room, Shaked and Olthoff took nearly two more hours to complete the operation and staple closed the long incision that arched across Nadia’s belly. At 5:30 p.m., Nadia’s transplant was finished. The anesthesiologist wheeled the little girl to the pediatric intensive care unit (PICU) on the seventh floor of the south tower, directly below 8 South. The surgeons went out to talk with Joe. Up in the PICU with Nadia, Rand made sure everyone knew the plan for the toddler’s postoperative care. She stood at Nadia’s bedside, passing a palm over the child’s forehead, checking her one last time. Joe was soon allowed to join Nadia in the PICU. He resumed his vigil over his baby. He still couldn’t bring himself to sleep. Nadia slept hooked up to monitors that would signal the slightest change in her vital signs to nurses watching her around the clock. The girl’s yellow tinge was already fading. Before going home, Olthoff checked on Nadia in the PICU. She would get some time with her sons that night. She would try to get some rest. The next day she had another transplant. Nadia’s numbers Rand followed Nadia’s progress daily. After Nadia spent several days in the PICU, her breathing tube was removed. She was transferred to 8 South. Nurses took blood to test enzyme levels. Those numbers would give the hepatologist and Nadia’s surgeons a sense of how Nadia’s body was reacting to her new liver. The numbers dropped the week after the transplant, a good sign. On April 12, Rand visited the family on 8 South one last time before leaving for her mastectomy the next day. She expected to be home recovering for three weeks. But then, at the end of the next week, Nadia’s numbers began to climb. The doctors grew worried. Olthoff and Shaked consulted with Rand as the hepatologist recuperated at home. On April 19, Rand ordered an ultrasound to make sure a clot was not blocking blood flow to Nadia’s new liver. There was no clot. She then ordered a biopsy. The results were clear: Nadia was rejecting her new liver. Contact staff writer Josh Goldstein at 215-854-4733 or jgoldstein@phillynews.com. Posted with permission from The Philadelphia Inquirer. Copyright © 2008. All rights reserved. #1-23093959 Managed by The YGS Group, 717.399.1900. For more information visit www.theYGSgroup.com/reprints.

Philadelphia Inquirer - Children's Hospital of Philadelphia

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