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OneThousandOne represents the amount of time, verbally, that it takes to count to one second. In this one second of time, a great thing happened at The Nebraska Medical Center. In fact, several great things probably happened. A patient was cured, a researcher found the missing link, a nurse treated an injury, a doctor comforted a family or maybe a child just smiled.
MOMENTS IN MEDICINE at THE NEBRASKA MEDICAL CENTER
Fall | Winter 2012

Good As Gold

Medal

Thirteen-year-old Peter Jurich took home gold this summer.

Competing in swimming at the Transplant Games of America for the first time, Peter proudly donned six gold and two silver medals around his neck when the Games were over.

But what Peter is even prouder about is the fact that he achieved this amazing feat after undergoing a liver transplant at The Nebraska Medical Center three summers ago.

“Peter views his transplant as a gift,” says his mother, Carol Jurich. “Going into his first Transplant Games, he just wanted to do the very best he could with this gift he has been given.”

It was approximately four years ago that the Juriches received the news that Peter’s liver was functioning at just 10 percent. Doctors had been monitoring his liver since he was a baby.

Several months after Peter was born, it was discovered that he had an enlarged spleen, which is indicative of liver dysfunction. Initially, he was diagnosed with advanced cirrhosis and a liver disease that would require a transplant almost immediately. But further testing indicated this wasn’t the case. Not sure what was causing the problem, his doctors decided to hold off on any treatment and monitor him closely. The Juriches lived in Chicago at the time.

About a year later, Peter’s father, Joe, received a job offer in Lincoln, Neb. Doctors at the Chicago hospital told the Juriches that The Nebraska Medical Center, located in Omaha, had one of the top pediatric liver programs in the country. The Juriches decided that fate must be drawing them closer to Omaha and Joe accepted the job in Lincoln, less than an hour away from The Nebraska Medical Center.

“He just wanted to do the very best he could with this gift he
has been given.”
Carol Jurich

At Peter’s first evaluation in Omaha, a battery of tests was administered and a review of all previous lab work and tests was performed. The review led to the diagnosis of congenital hepatic fibrosis (CHF). The disease is associated with a malformation of the bile ducts and the blood vessels that carry blood from the gastrointestinal tract to the liver. This malformation causes blood to back up, which causes the spleen and veins to enlarge and portal hypertension to develop. (The hepatic port vein carries blood from the gastrointestinal tract and spleen to the liver.) As the veins stretch and the walls become thinner, there is increased risk for infection and internal bleeding due to a rupture of the veins. Peter’s spleen was only slightly enlarged, so again, doctors opted to watch and wait.

The Juriches continued to have Peter’s lab work and ultrasounds performed in Lincoln. They came to The Nebraska Medical Center clinic every six months for Peter to be monitored. In the meantime, he was given the green light to play sports and be a kid.

And boy did he. Peter loved sports. He played soccer, baseball and basketball and swam during the summers. But the older he got, the more difficult it became for Peter to keep up with his teammates. By the time he was 7 or 8 years old, he was beginning to become more uncomfortable and fatigued.

It was August 2008 at their biannual appointment at The Nebraska Medical Center when the Juriches learned that Peter’s portal hypertension had worsened. He was now at risk for a rupture of the veins in the lower esophagus. The Juriches prepared for Peter’s surgery in October to alleviate the hypertension.

But again, things weren’t what they seemed. When the Juriches arrived at The Nebraska Medical Center in October for a series of pre-operative appointments, the results indicated that something else was going on. The Juriches’ doctor, Dean Antonson, MD, pediatric gastroenterologist/hepatologist, was no longer convinced Peter had CHF. So the surgery was postponed and Peter returned to Lincoln.

Pool

Over the course of the next week and following months, additional testing was conducted, eventually culminating in an open liver biopsy. Still, Dr. Antonson and his colleagues were unsure of the diagnosis. Peter’s symptoms didn’t seem to fit any one specific disease. But what they were sure of was that Peter’s condition was getting worse. For the first time since he was a baby, the word transplant was uttered.

“We were shocked,” recalls Carol. “No one had mentioned transplant for years. We were really scared.”

By January 2009, Peter’s liver was functioning at just 10 percent. He was in end-stage liver disease. A liver transplant was the only thing that could cure his condition, the Juriches were told. Peter was just 9 years old.

After several days of testing to determine if Peter met transplant qualifications, he was put on the transplant list. “Once we were on the transplant list, everything changed,” says Carol. “We were now officially part of the transplant group.”

Peter had labs drawn in Lincoln every two weeks, which were monitored by the team at The Nebraska Medical Center. They put him on a rigorous vitamin regimen, which they adjusted as needed in response to the lab results.

“We tried to maintain life as normal,” says Carol. “ We realized that there was no guarantee that a liver would become available, but you can’t just stop living. So Peter continued with Cub Scouts, baseball and swimming, though we decided it was best for him to take a bye on spring soccer.”

David Mercer, MD, Phd
David Mercer, MD, Phd

In March, Peter’s mother was evaluated to determine if she could be a living donor for him. They shared the same blood type, but a final analysis of a computer-generated model indicated that it would not be possible to leave enough of her own liver for the transplant to be safe for Carol. During spring break, the Juriches got the news that Carol would not be able to be Peter’s living donor. “To say that it was a difficult moment for all of us would be a vast understatement,” says Carol. But the family decided to move forward into the summer, focusing on all that Peter could do and confident in the transplant team.

Then, on Aug. 26, 2009, Peter’s fourth day of 4th grade, the Juriches got the call — a potential liver had become available.

Peter says that he was more excited than scared when they received the call. “I was a little nervous, but I knew that the doctors were going to take good care of me and that I was going to be OK,” he says. “I also felt bad because I knew that it meant that someone else was making a decision to be a donor.”

The Juriches arrived at The Nebraska Medical Center at about 11 a.m. After an initial postponement in pre-surgical preparations, Peter was finally taken to the operating room and prepped for surgery just after midnight. That’s when Dr. David Mercer, MD, PhD, liver and transplant surgeon at The Nebraska Medical Center, arrived. The Juriches had met Dr. Mercer during the lengthy transplant evaluation process and had been impressed by his medical and surgical credentials, as well as his positive and caring nature.

“When Peter met Dr. Mercer, it was a magical moment. He was confident, fun, disarming and compassionate.”
Carol Jurich

“When Peter met Dr. Mercer, it was a magical moment,” recalls Carol. “He was confident, fun, disarming and compassionate. Peter clicked with him right away. So to have him as Peter’s transplant surgeon was indescribably reassuring.”

Dr. Mercer is also director of the Intestinal Rehabilitation Program, a program that works hand-in-hand with intestinal and liver transplant patients, and an associate professor of Surgery at the University of Nebraska Medical Center (UNMC).

Peter Jurich
Peter Jurich

The Nebraska Medical Center has been a leader in adult and pediatric liver transplants since the program was founded in 1985 and averages approximately 20 to 25 pediatric transplants a year.

“We are one of the oldest and busiest programs in the country with the strongest group of surgeons in the country and probably the world,” says Dr. Mercer. “We have technically excellent surgeons with many years of experience who are backed by a large pool of pediatric specialists, including pediatric hepatologists, intestinal failure specialists and liver/kidney infectious disease specialists.

The pediatric program has a large infrastructure that ensures all of a patient’s and his or her family’s needs are met. “We have more than 150 health-care professionals and support people who are a part of the program,” says Dr. Mercer. “When families come here for a transplant, we don’t want them to have to worry about anything else but their child.”

“Our program has a tremendous amount of experience in caring for children with the most complex problems,” says Alan Langnas, DO, director of the liver transplant program. “We are committed to not only providing the highest quality of care, but also to innovate and to push for new treatment advances so that we can provide more opportunities for people to receive life-saving therapies.”

The liver transplant program also has the advantage of being supported by one of the leading intestinal rehabilitation programs in the country. “Many liver diseases are intestinal-based,” notes Dr. Mercer. “Our goal is to reverse their intestinal and liver disease so they won’t need a transplant at all. We can reverse the disease in about 75 percent of cases if they come to us early enough in the disease process.”

“I feel a lot more energetic
now. I’m faster, stronger and
I have more energy.”
Peter Jurich

For patients who receive a liver transplant, the outlook is good. The five-year survival is 80 percent or more, says Dr. Mercer. Most patients go on to live a normal life aside from the two immunosuppressant drugs they must take daily. They can do just about anything they want to do, says Dr. Mercer — even go to the Olympics. Several Olympians have been liver transplant patients, including snowboarder Chris Klug and bobsled competitor Howard Dell, whom Peter met at the Transplant Games.

“Pediatric transplants have continued to improve over the years,” says Dr. Mercer. “It’s become a razor-clean procedure. The surgeries are shorter, blood loss is less and the hearts and kidneys are getting stronger faster. Our ability to care for children after the surgery is also getting better and more refined. Most children can go home within a week or two.”

Peter’s four-hour surgery went flawlessly. “When he came out of surgery, Dr. Mercer said Peter was doing great,” says Carol. “’He said ‘it was a perfect fit.’”

Peter was in the hospital for 10 days, but by the tenth day, “they kicked him out,” says Carol. “He was doing too well to stay any longer.”

The 10 days went by quickly. Peter loved being able to order from the menu whenever he wanted. At night, when things were quiet, he and his mother would pretend to be Harry Potter and explore the hallways and lower tunnels of the hospital. One night, he even got to meet the emergency helicopter pilot and got a personal tour of the heliport and helicopter.

Carol, with son, peter
Carol, with son, peter

Peter developed a close relationship with his doctors and nurses. He bonded especially with Dr. Mercer, who was a swimmer and hockey player in high school. The two connected over their love for sports. And when Dr. Mercer showed Peter some key moves while playing a Star Wars video game, the bond was cemented.

“Dr. Mercer was a huge inspiration for Peter,” says Carol. “He was so reassuring and compassionate. His care all around was unbelievable. I’ve never seen a slogan that was more 100 percent on than ‘Serious Medicine. Extraordinary Care.’ We experienced that with everyone from the medical staff and nurses to the people who clean your rooms and the people in the cafeteria. These are some really special people there who take their jobs seriously. They’re not just punching in on the clock.”

Peter was back in school in four weeks. ”It was as if he hardly missed a thing,” says Carol. “He jumped right back in.” By January, Peter was back to playing basketball and soccer in the spring. Inspired by Dr. Mercer, he also started a new sport — hockey.

With his liver functioning at 100 percent, Peter began to put on some additional weight and muscle tone. “We didn’t realize how thin he was until we looked at his old pictures,” says Carol. “We had gotten so used to him the old way, we didn’t know what was normal and what wasn’t. His arms and upper body are so much stronger and he doesn’t get so winded anymore.”

“I feel a lot more energetic now,” says Peter. “I’m faster, stronger and I have more energy.”

Peter also has a bigger perspective on life. “Sometimes he struggles with how to make the best of what’s been given him,” says Carol. “I just tell him that his job is just to be a kid. It’s true that every day is a gift, but you have to live normally, too. You can’t expect yourself to be superhuman.”

Peter is planning to compete in the next Transplant Games in two years. But he also has bigger goals beyond the Games. Inspired by the surgeon who transplanted his own liver, Peter hopes to some day become a liver transplant surgeon.

And according to Dr. Mercer, “Peter is doing great. The transplant hasn’t slowed him down a bit. He should be able to do anything he wants to do — whether that’s becoming a surgeon or an Olympian.”

Or put another way, he’s as good as gold.

Next article in the Fall | Winter 2012 issue of One Thousand And One:
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