Cristina and Angel DeJesus each have a kidney today.
That’s because on Tuesday, both the diseased and enlarged kidneys were removed from Angel DeJesus in robotic surgery, and he’s now receiving one from his wife in a double transplant operation at Yale New Haven Hospital.
While DeJesus, 40, ended up having a traditional incision because his kidneys were so large, the couple have a lot to be grateful for.
Cristina DeJesus, 36, had her kidney removed via laparoscopic surgery in an adjacent operating room and both were doing well as of Wednesday morning, according to a hospital spokesman.
“Most of us feel pretty full on Thanksgiving,” said Dr. David Mulligan, director of the Yale New Haven Transplant Center. “He’ll feel like he could eat another turkey.”
That’s because Baez suffers from polycystic kidney disease, a genetic disorder that caused his kidneys to fill with cysts, enlarging them so that they pressed against his other organs. Each weighed about 20 pounds after many cysts had been drained of fluid, and according to his surgeon, Dr. Danielle Haakinson is over 18 inches long compared to about 1 pound for a normal kidney.
A parent with the gene for polycystic kidney disease has a 50 percent chance of passing it on to their children, Mulligan said, and two of the DeJesuses’ four children have the disease. Large cysts form on the kidney, some of which are filled with one to two cups of fluid, Haakinson said.
“He really struggles to eat well and have a good appetite because his bowels have been squeezed for so many years,” Mulligan said. Meanwhile, his upper body was bloated. “He came in looking nine months pregnant,” Mulligan said.
“When we match a kidney, the most important thing we do is the blood type,” Haakinson said. Both Cristina and Angel DeJesus have the same blood type, allowing for transplantation between spouses. Cristina DeJesus’ surgery was performed by Dr. Sanjay Kulkarni directed.
But there may not be a match “if a patient has had blood transfusions, or is a mother who has had babies, or has had any sensitizing event where she was exposed to blood products,” Haakinson said.
However, DeJesus has to wait for the turkey. “His guts are going to be a little sleepy,” Mulligan said. DeJesus will be limited to “clear liquids upon waking,” he said.
The twin surgeries should last a total of eight hours. Cristina DeJesus was due to be released Thursday.
Angel DeJesus will be released in three to five days, Haakinson said, largely because his kidneys were so large. “So we could do it from an incision that went from his sternum to just below his belly button, and then we can do his kidney transplant through that same incision.”
The robotic surgery, which involves multiple small incisions to allow the da Vinci robotic instruments to be inserted, is impractical given Angel Baez’s condition, she said.
During the robot part, the first step was to close the inferior vena cava, the large vein that brings blood to the heart and the main artery that supplies blood to the kidney, with a special stapler. Then the blood vessels were severed. The ureter also had to be severed.
Next, surgeons removed the connective tissue from the kidney to the liver, diaphragm, back muscles, and intestines. When DeJesus’ new kidney was implanted, it would be free of these compounds.
While the surgeons drained many of DeJesus’ cysts to avoid incision, Haakinson said the fluid was suctioned out. That’s because they contain cytokines, which are part of the immune system.
“They can create an inflammatory response,” Mulligan said. The result can be fever and dilated blood vessels. “It’s like the flu in a lot of ways. … We’re trying to open only what’s necessary to avoid those side effects.”
They also had to get organs like the adrenal glands out of the way.
“It’s a tough day,” Haakinson said during the surgery. “We knew it was going to be a difficult case. His kidneys are extremely large and he’s a 6½ foot man so he has big kidneys.”
The da Vinci robot is “a massive instrument,” she said. “It has been used since 1990. The very first kidney transplant was performed at the University of Illinois, Chicago in 2008.”
Yale New Haven flew its doctors and nurses there for training, as well as to Detroit’s Henry Ford Hospital. “They’ve helped us a lot,” Haakinson said. “Our technique is a mixture of these two techniques.”
The first robotic kidney transplant in New England was performed at Yale New Haven in October 2019, Haakinson said. “The pandemic messed things up for a while,” she said. “The transplant kind of shut down.”
Haakinson said she has performed 20 robotic kidney transplants, three of them in patients with polycystic kidney disease. Yale New Haven is the only New England hospital performing the surgery. The closest is in Maryland.
Hartford Hospital, the state’s other transplant center, is training a doctor so he can start the procedure next year, according to a spokeswoman for Hartford HealthCare.
“It’s a rarer condition to take care of,” Haakinson said. “At Yale we have special nephrology expertise and so on. Historically, many patients with this disorder have been drawn to Yale because it is a genetic condition. … We have already transplanted three generations of family members.”
One reason for using the robot is that people with polycystic kidney disease can herniate easily, so it’s best not to weaken the core muscles. Other reasons are patients with HIV, to protect the surgical team, or for someone who is morbidly obese.
“We’re trying to be thoughtful and selective about who’s really going to benefit,” Haakinson said.
She said the hospital is also taking a holistic approach to pain, using a nerve block before surgery and avoiding narcotic painkillers. She said both Baezes will likely just need Tylenol to control their pain.
While Angel DeJesus wants to get back to work as soon as possible, he will have to wait eight to 12 weeks because the drugs used to suppress his immune system also slow healing, Haakinson said.
“So a normal person with normal tissue, your scars are going to be as bad as they are going to be in six weeks,” she said. “But in someone with immunosuppression, it’s not going to be as severe as it’s going to be for about three months.”
The doctors waited to plan the surgery until DeJesus’s kidneys began to fail. “He was barely on the brink with his kidney function,” Haakinson said. He’s been on dialysis for a week.
“It was a perfect time,” said Cristina DeJesus. “It was shocking that I was a match, that I was able to do that,” she said Wednesday. “I was shocked, but I was very happy. It was a long process” that began in February.
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“I had some challenges. … I had to hit a weight goal because I have a family history that they were concerned about,” she said. “So they wanted me at a certain weight. I was just glad I could do it before he got worse.”
The family, which includes four children ages 6 to 14, had Thanksgiving last week, Cristina DeJesus said. She said her two youngest had their father’s illness. “I hope they are as lucky as we are when their time comes,” she said. The family lives in Hamburg.
Cristina DeJesus’ laparoscopic surgery “is the standard of care” for kidney transplants, Kulkarni said. “What we’re doing is what’s called total laparoscopy,” as opposed to hand-assisted laparoscopy, he said.
“The majority of living kidney donors are women,” he said, up to 65%. “It’s very common when the wife gives something to the husband. … There is more kidney disease in the male population.
“It’s the same every year,” he said. “People who report as kidney donors year after year are more women.”
For more information on becoming a living organ donor, visit the Center for Living Organ Donors website or call 866-925-3897 (866-YALE-TXP).
Ed Stannard can be reached at [email protected].