Transplant Provides New Life for Little Boy

From the very beginning, Matthew suffered from a lower urinary tract obstruction that blocked the flow of urine and severely damaged his kidneys. “Matthew had no meaningful kidney function when he was born in January of 2009,” shares Susan R. Mendley, M.D., division head of Pediatric Nephrology and associate professor of Pediatrics and Medicine at the University of Maryland School of Medicine. “But that wasn’t a surprise since Dr. Christopher Harman, head of Maternal/Fetal Medicine at the University of Maryland Medical Center, had diagnosed that possibility at 27 weeks in-utero. We just didn’t know how severe Matthew’s case would be until he was delivered.”

Three Months in the NICU

At birth Matthew was taken to the neonatal intensive care unit (NICU) at the University of Maryland Children's Hospital. His urinary system was blocked by his posterior urethral valves, which meant his kidneys did not develop normally and they failed to function. He also had under-developed lungs so he required a ventilator for many weeks.

Neonatologist Rose Viscardi, M.D., recognized on his first X-ray that Matthew had a pneumothorax, a condition that caused the collapse of his right lung, requiring an emergency chest tube insertion. Dr. Viscardi quickly explained to Matthew’s dad, Tom, what needed to be done. There were many conversations among the parents and providers to explain and coordinate care for Matthew, as he had many ups and downs in the NICU.

“It was determined pretty quickly that Matthew would require a kidney transplant,” Nicole says. Drs. Viscardi and Mendley, the pediatric nephrologist, met Matthew and his family in the NICU so together they could devise a management plan for Matthew’s many medical challenges.

Getting nourishment was an issue from day one. A feeding tube was necessary to provide Matthew with nutrition. “With renal failure, foods often taste bad,” Nicole says. “An oral aversion developed. Matthew never knew anything different. To this day, getting Matthew to eat properly is a challenge.”

Matthew needed five surgeries before he left the hospital at three months old – everything from opening the valves that were blocking his urethra, to the placement and removal of catheters and a feeding tube, to hernia repair. A total of 12 surgical/procedural interventions would ultimately take place – including a kidney transplant at 18 months. Before the transplant, Matthew required daily peritoneal dialysis until the kidney transplant could be completed.

A Lifesaver: Peritoneal Dialysis

Before leaving the University of Maryland Children's Hospital at age 3 months and up until his kidney transplant at 18 months, Matthew Colantuno required daily peritoneal dialysis. His parents, Tom and Nicole, went through the extensive training required to perform peritoneal dialysis from the comfort of the family’s home.

This form of dialysis uses the lining of the child’s abdominal cavity – the peritoneum – as a filter. A catheter is inserted in the child’s belly and used to fill the abdominal cavity with a solution that draws waste and extra fluid from the blood. Then the solution is drained along with the wastes and fluid. This cleaning process is repeated multiple times during each daily dialysis session.

The primary advantages of peritoneal dialysis are that the process can be done at home while the child sleeps and without the presence of a health professional. The dialysis fluid also stretches out the child’s abdomen making more room for the adult-size kidney to be transplanted.

“Nicole and Tom are extraordinary caregivers,” Dr. Susan Mendley shares. “They were diligent about the dialysis training required, meticulous with the procedure and not afraid to ask questions.”

Finding a Compatible Donor – Right at Home

“We had extreme confidence in Dr. Mendley and her plan for managing Matthew’s kidney disease,” Nicole notes. “That confidence – along with training – allowed Tom and me to share dialysis duties for Matthew at home.”

The search for a kidney donor then began. Nicole had an incompatible blood type. However, father and son matched! “Matthew is very fortunate that his father has the same blood type,” Dr. Mendley says. “Finding a compatible kidney donor from with the family eliminates many of the challenges and much of the stress of an organ transplant.”

Waiting for Matthew to grow large enough – 22 pounds – for an adult-size kidney transplant was our next move,” Nicole says. “The transplant itself went very smoothly. We can’t say enough about the skills and professionalism of Matthew’s surgeons – Dr. Eugene Schweitzer and Dr. Roger Voigt. They were incredible.”

A Prognosis Full of Hope and Life

Matthew received both physical and occupational therapy before the transplant. “He has done remarkably well,” Nicole says. “Matthew now shows age-appropriate development of gross and fine motor skills. He has been discharged from physical therapy. He still receives occupational therapy to help with his eating. But he’s a happy boy – leading an active, normal life.”

“Matthew will be our patient for a long time,” Dr. Mendley says. “But full rehabilitation is expected. And even though he will be treated for kidney disease the rest of his life, I predict it will be a full life indeed.”