A big kidney for a tiny boy

A big kidney for a tiny boy

By JARED STRONG • jstrong@dmreg.com • March 18, 2009

The tumors could form on Trae Hamilton's tiny kidneys any day.

A vast majority of children with his rare condition suffer kidney failure before kindergarten. The cancer sometimes invades other parts of the body.

Before any of that happens, doctors hope to remove the faulty organs and replace them with one adult kidney. It will stay in Trae's abdomen for more than 20 years. His stomach will bulge at first from the oversized organ, but will fade with time.
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Trae's surgeon has done the procedure before, but it's always a challenge to fit an adult organ in a child — especially one this small.

Doctors want the kidneys out before Trae is 18 months old. That's a month away. The operation has already been delayed once. The alternative is chemotherapy if the cancer starts, which will wreak havoc on the child's body.

"It's something you don't believe at first," said Trae's dad, Travis Hamilton of Urbandale. "How can it happen to us when it rarely happens to anyone?"
Early stage of kidney failure

Doctors at Blank Children's Hospital in Des Moines moved Trae to intensive care shortly after he was born in October 2007.

Trae was smaller than he was supposed to be, and his body temperature was low. An X-ray showed that one of his kidneys had two sets of connectors to his bladder. He was in the early stages of kidney failure.

A specialist later suspected a rare disease that has about 400 diagnosed cases worldwide. It's caused by a missing gene that keeps cell growth in check. Researchers still are not sure of the cause.

Since the diagnosis, Trae has been examined every few weeks for signs of the cancer. No tumors yet, but Trae has high blood pressure and his body doesn't retain the amount of protein it should. He takes medicine twice a day for both problems.

Outwardly, Trae's a normal kid who is full of smiles. He loves playground slides, and he has a small scar above his right eyebrow from when ran too fast and tripped and fell on a toy police car. When a basketball or hockey game is on TV, Trae stands in the middle of the living room and watches.
Search for kidney

The search for a kidney donor began in November.

The doctors said a parent or sibling would be best, but Trae's mom, Emily, isn't eligible because she has multiple sclerosis. He has no brothers or sisters.

That narrowed the candidates to Trae's dad.

Other relatives and friends volunteered their kidneys if dad was not a transplant match, Hamilton said. "But deep down, I really wanted to be the donor."

It began with a questionnaire. The doctors wanted to know the family's medical history.

Then Travis gave six vials of his blood to test for disease and blood type. There was a problem with how the blood was collected, so he gave more.

Some of the blood was used to determine whether his son's body would reject dad's kidney. There are six proteins that Trae's body uses to identify its own cells. Half of those proteins came from dad's genes. They wanted at least one more to match.

"Those decisions are fairly straightforward," said Dr. Alan Reed, the University of Iowa surgeon who will perform the four-hour procedure. "It's just science. Parents are always a good option. They are highly motivated."

But that doesn't always mean that they can donate.

The alternative was a transplant waiting list. Some people wait years for a kidney. In the meantime, Trae's would be removed, and he'd have to spend up to six days a week in Iowa City, connected to a machine that would glean toxins from his blood.

Travis had to go through two more tests.

The doctors concluded that Travis's heart was healthy enough for the surgery. They used radiation to scan his body for other abnormalities. The heated dye they injected into him made his body burn. People who get the injection sometimes get a metallic taste, so Travis chewed six pieces of citrus-flavored gum.

Then, they waited.
Doctors confer

In Iowa City, a panel of doctors discussed the tests. They had to be sure that father and son were a match before they performed the unusual procedure.

In Urbandale, the Hamiltons resumed their lives. Christmas Day was near.

Travis, a police officer in Johnston, went back to work. Emily returned to a Bath & Body Works store that she manages.

Trae rested. He played patty-cake. He rode around the house in a toy police car that looks like dad's.
Hockey game benefit

The Hamiltons asked the Iowa Chops hockey team to play a benefit game.

Part of the ticket sales from their Saturday night game against Quad City will help pay for transplant expenses. So will all the proceeds from a silent auction during the game.

The Hamiltons have insurance, but that does not cover travel expenses. Trae will have to take expensive medication for the rest of his life to ensure his body doesn't reject the kidney.

Travis's telephone rang. It was the doctors in Iowa City. They're ready, they told him, to do the surgery.

It's set for March 26.

And dad is the donor.

http://www.desmoinesregister.com/article/20090318/NEWS/903180360/1001/