Wednesday, February 22, 2012
The Playground and Rejection. . .
Rejection has lots of meanings for different people and different events. Rejected by a sweetheart, rejected by a team, rejected by friends. . . the list goes on. However, in the world of transplant, rejection has a much more specific and sinister meaning. . .
I'll use the analogy of a playground.
Before the transplant, the immune system is happily playing in the playground (Trayvon's body). Everyone is friends, and only occasionally does someone get out of line and cause a problem (infection). There are big kids and little kids on this playground. The little kids (b-cells) are trained well by the older kids (t-cells). As long as everyone is recognized and not an outsider within the very distinct boundries of this playground, everyone goes about their own business. Among the older kids there are a variety of personalities, but most are friendly and not overally aggressive. However, there are some bullies, as there are on every playground. Those awful kids who think they know and rule all and will squash those beneath them with cruelty.
Then we transplant. . . it doesn't matter what it is that is transplanted, but in this case, it's Trayvon's beautiful new heart. . .
In the first days after transplant, incredibly strong medications are used to kick the older kids right off the playground. We don't want them around to teach the younger ones any tricks or encourage any nonsense. It is hoped, that virtually all of the big kids take a hike but if any hang out, we hope they aren't bullies. With just little kids around, they may get curious and "check out" the new guy in town, they may taunt, tease or even just try to play, but with some subtle reminders from the teachers (his anti-rejection medications) they will just move along and ignore the stranger all together with no further thought paid to him.
But, if a bully hangs around, or several older kids find a place to hide and come out to check out the "new kid on the block", you begin to have a problem. If a big kid finds the new kid, they will, without a doubt, assault the poor thing with everything in their arsenal. In addition, they will recruit the little kids to do the same and "teach" them how to get rid of the intruder. This is called rejection.
It's a lonely existence for Trayvon's new heart. It is not to be recognized, it's not to be befriended, it's not to be looked at, or acknowledged in any way. The anti-rejection meds are there to ensure this and provide a type of protection, by constantly ridding the playground of any older kids and scolding the younger ones whose curiosity gets the best of them.
If rejection occurs, and it's above more than a simple acknowledgment of the heart by the immune system, immediate action must be taken. In most cases, when it's just the little kids (b-cells), you can trick them by using steroids or IVIG to redirect their attention and to send them on their way. However, if the big kids get into the picture, then heavier guns, higher doses of meds and hospitalization is required. The immune system can NEVER get the upper hand or it will tear his beautiful new heart apart, cell by cell. So, we now live in the world of fine lines.
Suppressing his immune system sufficiently to render it helpless in recognizing the heart. However, not suppressing it to the point it where it will not be sufficient to fight a simple illness and allow things as basic as a cold to become life threatening. He will take lots of "prophylactic" medications aimed at preventing an illness from happening in the first place. Tray will wear a mask in public for several months. He will not be able to shake hands or hug for a few months. He will need to have biopsies done frequently to be sure it's all happy and hunky dory on the transplant playground.
Eventually, the immune suppression is reduced tiny bit by tiny bit to allow enough big kids on the playground to fight infections, but not enough to be able to detect and harm our precious gift. So they monitor his blood levels daily of his anti-rejection meds. His kidney function and liver function are followed very closely. His heart is looked at on echo regularly to try and catch problems early.
This is the way of Trayvon's new life with his heart. But, he'll be able to run, play, live and be free of wires, oxygen and IV's, so the trade-off is well, well, worth it.