Sharing Mayo Clinic: Bring this young patient now

Sharing Mayo Clinic: Bring this young patient now

By
Dana Sparks

October 29, 2017

When 4-year-old Maksim Messerer's kidney function declined suddenly and unexpectedly, surgical staff from across Mayo Clinic quickly came together to perform his kidney transplant several weeks ahead of schedule.

New Year's Eve is supposed to be a time of celebration and hope. But for Jeremiah and Rachael Messerer, Dec. 31, 2014, was anything but celebratory. As people around the world gathered to ring in the New Year, Jeremiah and Rachael were inside a pediatric intensive care unit in Minneapolis, Minnesota, with their young son, Maksim.

Admitted for severe lethargy and dehydration, Maksim quickly got worse instead of better. Doctors discovered he'd been infected with E. coli, which then suddenly progressed to hemolytic uremic syndrome and kidney failure.

"He began peritoneal dialysis the very next day," Jeremiah says. "A week later he went into septic shock and was intubated. He was in a very critical state, and his doctors were very concerned."

So were his parents. And that concern would only grow when Maksim was taken in for a major surgery of his abdomen, during which the majority of his large intestine was removed. "At that time he was also switched over to hemodialysis," Jeremiah says.

After spending almost three months in the hospital, Maksim was allowed to go home. Over the next year, however, he'd return to the hospital three times a week for dialysis. And it was during this time that talk of a kidney transplant first began to take place.

"It seemed pretty obvious early in his recovery that a kidney transplant was going to be in his future," Jeremiah says.

A search for the best fit

With that prognosis in mind, Jeremiah and Rachael began searching the country for the best transplant center for Maksim. It was a long, exhaustive process that eventually led them to two finalists, one of which was Mayo Clinic.

"After we did a transplant evaluation at Mayo, we had this really strong sense of the team there," Jeremiah says. "They listened to all of our concerns and were willing to work with us and consider, collectively, what the best treatment plan was for Maksim going forward."

What ultimately sold Jeremiah and Rachael on Mayo Clinic, however, was transplant surgeon Mikel Prieto, M.D. Jeremiah says the level of care and compassion shown to them by Dr. Prieto just minutes into their initial meeting together is what made them realize their search for a transplant center, and a transplant surgeon, had ended.

"We had this really strong sense of the team there. They listened to all of our concerns and were willing to work with us and consider, collectively, what the best treatment plan was for Maksim going forward." — Jeremiah Messerer

"We'd seen a lot of doctors before coming to Mayo. Within 10 minutes of meeting Dr. Prieto, he handed us his card with his personal cell phone number on it," Jeremiah says. "That's the level of care and compassion he has for his patients."

By the time of their meeting with Dr. Prieto, Jeremiah had already gone through a complete kidney donor evaluation at another health care facility that had determined he was a match for Maksim. When three days of testing at Mayo Clinic confirmed that, Jeremiah says he felt an instant wave of relief.

"It was just a massive sense of relief that when the time for a transplant came, we wouldn't necessarily be scrounging to find a donor," he says.

A sudden turn of events

With Jeremiah officially approved as the donor, Dr. Prieto scheduled Maksim's kidney transplant for July 18, 2017. It could have happened sooner, but Rachael was due to give birth to the family's third child in June. She'd wanted some time to recover before going down the transplant road with Maksim.

Unfortunately, those plans would all change. Initially, Maksim had required dialysis for 18 months after he was first admitted to the hospital in Minneapolis. Then, for no clear reason, his kidneys recovered just enough for his body to function without it. However, Maksim's health care providers warned the family that wouldn't last forever. It was only a matter of time before Maksim would again need dialysis. In late June 2017, as predicted, Maksim's kidney function declined to the point that dialysis would be necessary.

"Dr. [Carl] Cramer, who's a pediatric transplant nephrologist here at Mayo Clinic, called me and said that Maksim wasn't doing very well, and that his kidney function wasn't going to last another three weeks," Dr. Prieto says. "He said Maksim was going to need to start dialysis very soon."

The only other option would be to move his transplant date up. There was just one problem. Dr. Cramer's call came on a Monday, and Dr. Prieto was scheduled to be away for two-and-a-half weeks, starting later that same week. That didn't stop him from putting Maksim's needs first.

"All of this was scheduled to happen on July 18. But I was being told that Maksim wasn't going to make it to July 18, so I said, 'OK, let's bring the family to Mayo Clinic now.' This was in the evening," Dr. Prieto says. "I said, 'Let's call the family and see if they're willing to have their lives upended like this so suddenly.' We called them and said, 'If you can get here tomorrow, we can do Maksim's transplant tomorrow.'"

After some brief discussion, Jeremiah and Rachael were in. "After praying and talking it over, we decided we'd like to move forward. The next morning we were on the road to Rochester by 9:30 a.m."

A plan in place

Meanwhile, back at Mayo Clinic, plans were being made for their arrival. "It's important to understand that when we first called the family, nothing had been scheduled," Dr. Prieto says. "No operating rooms, no surgical teams … nothing."

That all began to change with a call to Surgical Services manager Cheryl Christopherson.

"Everybody was so phenomenal and pulled together so well." — Cheryl Christopherson

"Dr. Prieto always calls me when he's made aware of a child who's going to need a kidney transplant," Christopherson says. "When he told me about Maksim, I knew I was going to need two operating rooms — one for Maksim and one for his dad."

Cheryl told Dr. Prieto she could make that happen and began working the phone lines.

"Everybody was so phenomenal and pulled together so well," she says. "I said, 'Here's the deal, we have this little guy, and we had his transplant scheduled. But we now have to do it today.' And everybody was like, 'OK. What do we need to do to help?'"

The answer to that question, Dr. Prieto says, was to come together as one Mayo Clinic with little to no warning.

"I got Saint Marys Hospital to give me two operating rooms, and they opened those up with no pre-planning. Then I had six or seven people from Methodist Hospital come with me to Saint Marys to do the procedures," Dr. Prieto says. "We had to have something like 30 people involved in all of this. We had to have two anesthesia teams, two nursing teams, two operating room teams. We combined people from Methodist who work with me regularly on adults with people from Saint Marys who work regularly with kids. And we managed to put those two operating teams together within a few hours, so that when Maksim and his dad arrived, we'd be ready."

And they were. "We got to Mayo Clinic around 11:30 a.m., and the admit desk was waiting for us by name," Jeremiah says. "After we got there, they took us up into pre-op and put Maksim and me in adjacent rooms. Then it was a flurry of pre-op activity from there. I was off to the operating room within an hour to an hour and a half of getting to Rochester."

A display of excellence

That's when Dr. Prieto and his surgical teams took over. "I did the surgery on Jeremiah starting around 1:30 p.m.," he says. "Then I did the transplant on Maksim. We were done with everything by 6:30 that night. They both did great."

Most importantly, they both continue to do well, which is a result Jeremiah and Rachael could not be more thankful for.

"We really can't express our gratitude for how quickly this all came together," Jeremiah says. "We feel really blessed that everything worked out the way that it did because we know it was the right thing for Maksim."

"My first call to the operating room was made that same morning to tell them that I'd like to do this. And they said yes. We were then able to put together a team of 30 people to get it all done. That, to me, is Mayo Clinic at its finest." — Mikel Prieto, M.D.

Everything worked out the way that it did, Dr. Prieto says, because the only interest being considered throughout it all was Maksim's.

"To put together two operating teams from basically nothing … my first call to the operating room was made that same morning to tell them that I'd like to do this," Dr. Prieto says. "And they said yes. We were then able to put together a team of 30 people to get it all done. That, to me, is Mayo Clinic at its finest."

That's a sentiment with which Dr. Cramer wholeheartedly agrees.

"Anywhere else, they would have put Maksim on dialysis and just waited for the date of the transplant," he says. "That would have definitely been the path of least resistance for us, too. But we felt that if we were able to avoid all of that, then that would certainly be in his best interest."

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