Kidney transplant patients can live normal and functional lives

MANILA, Philippines - Lenycia Torrecampo Gimeno has known for most of her life that she had a kidney problem. In 1978, when she was eight years old, she was diagnosed with glomerulonephritis (GN). The diagnosis surprised her, but with prescribed medications that she took for a year, she was able to overcome the disease.

When she got better, Gimeno went on to finish high school and college and after graduation began working in Naga City as a nurse. She barely thought about her earlier childhood diagnosis.

However, as she was working, she noticed that she had recurrent high white bloods cells (WBC) count in urine examinations and thought to be urinary tract infection that would be prescribed with antibiotics. She would take the medicine and get well, but before long the cycle would happen again.

In July 1994, Gimeno was alarmed to find out that her blood pressure had shot up to 200/120. It was a definite sign that something was wrong. She decided to go to the National Kidney and Transplant Institute (NKTI) for a checkup.

Diagnosed with ESRD

At NKTI, Gimeno was diagnosed to have permanent and irreversible kidney damage called end-stage renal disease (ESRD) secondary to chronic glomerulonephritis (CGN). She was advised to undergo regular dialysis.

“I was surprised to learn how advanced the disease was,” she recalled. “I was asymptomatic and I did not feel anything to indicate how bad the disease had gotten. But when I did the tests and got my laboratory results back while I was studying for the CGFNS nursing examination, I knew something was wrong. My hemoglobin was low and my kidneys seemed small. I knew it was important to get a doctor’s diagnosis as soon as possible.”

Even though Gimeno knew how important it was to see a doctor, she still delayed her appointment because she was in denial about how far her disease had progressed.

“It’s a common reaction,” she related. “I thought that if I could just put off hearing the diagnosis I would not have to accept it. But I knew I have to face it eventually and I was officially diagnosed with ESRD in NKTI in 1994.”

She began dialysis on that same year with peritoneal dialysis for one and a half years and then switched to hemodialysis. “The dialysis was really hard,” Gimeno shared. “I was weak and it was uncomfortable. I had to have water removed from my lungs in two separate occasions. I had to have dialysis sessions twice a week and not only the sessions were difficult, but they were expensive as well.”

Getting a kidney transplant

While undergoing dialysis, Gimeno had to resign from her work. She was not feeling physically capable despite her regular dialysis sessions and medicines. A kidney transplant was her best option to go back to her normal life, but she did not actively look for a kidney donor.

“I did not ask my brother, Henry Torrecampo who was the only probable candidate. I knew kidney disease ran on my father’s family, and I just did not want to ask him a favor,” she said. So she continued with her treatments.

But in December 1996, after two years and four months of dialysis, it was her brother who finally approached her and offered himself to be her kidney donor. He had noticed how his sister’s health and general well-being had deteriorated and he wanted to help. The siblings underwent extensive laboratory tests and were regarded a good match so the kidney transplant procedure was scheduled.

Gimeno had her kidney transplant surgery in March 1997. The procedure was successful and both recovered well. After 10 days in the hospital, she was able to go home to complete her recovery. “I was very blessed to have had such a successful operation,” she said. Her brother was able to return back to work.

Switching of immunosuppressive medicine

Like other kidney transplant patients, Gimeno had to be very careful about rejection and infections for at least six to 12 months after the surgery, as those are the critical period. She was given initial anti-rejection medications called immunosuppressants, which include cyclosporine, azathioprine and prednisone.

The function of the immunosuppresants was to dampen the immune system sufficiently to stop it from rejecting the transplanted kidney while still keeping it active enough to fight infection.

“Post-transplant, Gimeno was prescribed with immunosuppressants,” Dr. Concesa Cabanayan-Casasola, her attending nephrologist, recalled. “She had to take them along with hypertensive medicine and she was under close monitoring.”

However, several months post-transplant, the level of her liver enzymes was noted to be increasing and was diagnosed to be drug-induced hence azathioprine was discontinued. She was then on cyclosporine and prednisone from 1997 to 2009 with stable kidney function.

“I recovered well and everything seemed okay, but in July 2009, Dr. Casasola added mycophenolate mofetil to the treatment protocol because of rejections,” Gimeno said. She responded well to mycophenolate, experienced no side effects, and it became her regular daily maintenance medication.

In 2010, however, Gimeno briefly tried a new generic form of mycophenolate, but after consuming less than a box of the generic form she decided to stick to her original medicine. “I decided to stay on the original mycophenolate mofetil because it was working well for me and I did not want to risk a rejection by changing medicine. I thought it best to stick with the innovator drug, which is safe and has been proven effective in managing my condition than switch to something new. When it comes to rejections, I did not want to take a chance,” she said.

“Ms. Gimeno is a good patient and even after all these years, she takes her medicine religiously,” Casasola said. “Because of her compliance to medicine, she has managed to maintain her good health and has had no major problems since her transplant 16 years ago.”

Living her life

Since the transplant surgery, Gimeno has remained healthy and has taken her immunosuppressive medications regularly. One year after her transplant, she joined the Kidney Transplant Association of the Philippines Inc. (KITAP) and became a coordinator for the transplant patient support group.

Through KITAP, she has learned more about her disease and has also been able to help others who have to go through what she went through. “KITAP allows me to reach out to other kidney transplant patients and help them get through the problems that come with kidney disease, dialysis, transplants, and life after transplants,” she shared.

Through KITAP she has also found enrichment and has grown as a person. She even met her husband, Willfrendo Gimeno, through the organization, a nine-year post-transplant patient. They are happily married for over two years.

“It is possible to have a normal life after a kidney transplant,” Casasola said. “Patients just have to remember how important it is to regularly take their medications, regularly come in for follow-up check-ups, follow a low-fat, low-salt diet, and make small lifestyle modifications here and there to ensure they are far from possible infections and stay healthy and strong.”

Gimeno said, “A lot of people think once they have end-stage kidney disease their life, as they know it, is over. That is not true. With the amazing doctors and hospitals we have and the medications available, it is truly possible to get back to your life. You can work, get married, and even have a family. Just be sure to always look after yourself.”

“Be cognizant of your limitations and don’t push yourself too hard. Live life in moderation, have a strong support system from family and friends, and always pray. Patients will be amazed at how they can overcome kidney transplant,” she added.