CHICAGO -- It was 422 days at Northwestern Memorial Hospital.
That’s the length of Chicago resident Colette Hurd’s stay due to her idiopathic pulmonary arterial hypertension, a condition that affects blood vessels in the lungs and the right side of the heart and causes the heart and lungs to weaken over time.
“I didn’t even realize that something was wrong because I didn’t know the symptoms,” said Hurd, 57. “I just noticed that my stomach was collecting fluid and it looked like I was about eight months pregnant.
According to Northwestern Medicine lung transplant pulmonologist Dr. Ambalavanan Arunachalam, Hurd has a rare condition where the high blood pressure in her lungs restricted her heart to the extent that it could not pump blood properly and caused a lack of blood flow to other organs, including her kidneys.
Hurd was admitted to the hospital at the height of the pandemic in May 2020 with failing lungs. By July 2021, she was on a list for a double lung and kidney transplant, but her 5-foot-1-inch stature made finding a match difficult. As did Hurd having highly sensitized blood, with antibodies from previous blood transfusions that would interfere with her body accepting new organs.
Hurd said she got a call four times that a donor was found, calls that didn’t reach fruition due to complications with organs having a blood clot, pneumonia or nonmatching tissues.
“She was in the ICU for close to a year and she had several times where she almost died with the amount of medications that we had to keep her alive,” Arunachalam said. “She was on a continuous drip to support her blood pressure for months and months and she was also on daily dialysis to do the work for the kidneys.”
It was a fifth call that proved successful. On May 15, Hurd accepted organs that were not the right match for her with a protocol created by her transplant team to get rid of the antibodies in her bloodstream to make her a good match for new lungs and a kidney.
“She was not able to get any organs out there,” said Dr. Satish Nadig, director of Northwestern’s Comprehensive Transplant Center, an abdominal transplant surgeon and the chief of organ transplantation in the Department of Surgery at Northwestern University Feinberg School of Medicine. “So we did many immunologic maneuvers ... via medications and filtering off antibodies of the patient to reduce their memory response so that they can get a window to accept an organ. We weren’t able to get her completely desensitized, but we ended up taking lungs and kidneys of a positive crossmatch (a donor and recipient who are not compatible) and transplanted them into her and continued those protocols postoperatively.”
The augmented immunosuppression was a high-risk procedure, but it worked and after a six-hour surgery, Hurd is on the mend.
Hurd’s transplant protocol wiped her immune system through medications and plasmapheresis treatment immediately before and after transplant surgery. This involves removing blood through a catheter and circulating it in a machine to remove the antibodies. The process made Hurd the first lung and kidney transplant patient at Northwestern Medicine to receive this treatment, Nadig said.
“We went across a crossmatch for her and transplanted her successfully with the resources and expertise that we had here on the medical immunology side and the surgical side to get her out of the hospital,” he said. “The thing that’s quite interesting is not only did we offer desensitization for a triple-organ transplant, but we were able to manage her immune system postoperatively as well to allow her a chance to survive.”
Hurd was welcomed home with a surprise party of sorts when she arrived with her husband, Dennis, on Aug. 11. She’s looking forward to a normal life without restrictions, like her former limit of 1.2 liters of liquid per day. Although she knows she and others near her will have to continue to wear masks because of her compromised immune system, she is looking forward to simple things like taking a trip or just sitting on her backyard swing.
“Because she’s immunocompromised we still have to be very careful,” Dennis Hurd said. “They don’t want us to spend a lot of time out in public and we have to be careful about visitors and people that come to the house, but after 422 days of her being away from home, it will just be a pleasure to have her back at home.”
Colette Hurd’s regimen going forward is physical therapy three days a week and checking in with her transplant team once a week, which includes Nadig and Arunachalam.
She and her husband will not forget the relationships forged with staff within the hospital’s walls — people such as ICU occupational therapist Kari Brouwer, who helped Dennis Hurd surprise Colette with a vow renewal ceremony at the hospital chapel for their 20th wedding anniversary in August 2021.
The Hurds cannot say enough about the great care they received from all levels at the hospital, from the cleaning staff to the management.
“They never gave up on us when we couldn’t find a donor. They just tried to think of something else out of the box,” Colette Hurd said.
Dennis Hurd agreed. “This thing with her antibodies, when they came up against that, everybody went back and said what else can we do? What else can we try?” he said. “They just kept digging to get to this solution.”
He said he now understands the importance of people being organ donors on a different level.
“Colette and I have talked about this before … as she received these organs and as we celebrate, that’s through the generosity of someone else and their family,” he said. “They’re grieving the loss of their loved one and we’re very appreciative of the fact that they donated the organs or that person signed up to be an organ donor so Colette can live.”
Nadig said every year, there’s something different that happens in transplants that changes the paradigm and moves the needle. Hurd’s case is evidence of that.
“The fact that we did this in dual organs, but also went across a crossmatch too, allows us to push the field of transplant forward,” he said. “And say: What are we missing in medicine that maybe had been dogma, but maybe should be re-looked at to say, ‘Oh, we can actually do this with modern techniques.’ ”
