After two years of fighting liver disease, Dave Kline, 59, is going to receive an organ transplant from a living donor, an act that will spark new life in him.
Always a worker, Kline typically came home from his job at New Enterprise Stone & Lime Co. Inc. and headed out to his garage to do welding, tractor restorations and other projects. Around Christmas of 2016, he found himself more often resting on a recliner. He was gaining weight and his stomach was distended.
“There was no pain,” Kline said. “I just didn’t feel like doing nothing.”
In February 2017, he was diagnosed with Alpha-1 Antitrypsin Deficiency, a genetic, non-alcoholic form of cirrhosis of the liver. He was told he would eventually need a transplant, but with medications his condition stabilized.
“I felt good enough to work 12, 14 hours a day,” Kline said.
This lasted until June 2018. He developed hepatic encephalopathy, which comes from toxins not being cleaned from the body and which can alter a person’s mental status. The first episode happened at work, where Kline had trouble putting the key in the ignition and was unstable on his feet.
“I was way out in left field,” Kline said. “I had no idea what I was doing.”
At the hospital, tests showed his ammonia level was 114 — it is supposed to be 70 or below. Powerful laxatives were prescribed to flush his system. He was barred from working and driving. More bouts of encephalopathy followed.
“He wouldn’t know the current year. He wouldn’t know the name of the president,” said Kline’s wife, Wanda.
Finally he was prescribed Xifaxan to help control encephalopathy.
“It is expensive, but thankfully our insurance covers it,” Wanda said. “But I’d take a loan out to pay for it if I had to.”
In October, Kline awoke with the foggy signs of encephalopathy. Wanda sent him back to bed and stayed home with him. At 8 a.m., she found him unresponsive. She shouted for her daughter, Naomi Kline, 25.
“We just couldn’t wake him up,” Wanda said. “I’m not even sure he was breathing.”
They called 911, and for the next several days Kline was hospitalized. His ammonia level had soared to 327. Doctors told Wanda they’d never seen it that high.
Testing takes place
It was time to start the liver transplant evaluation process. At UPMC Susquehanna’s Living Donor Liver Transplant Clinic in Williamsport, Dave met with Swaytha Ganesh, M.D., medical director of the UPMC Living Donor Program in Pittsburgh.
“She’s great. We love her,” Wanda said. “She’s helped us so much.”
In December, Kline underwent multiple tests. When a technician brought in 36 vials for blood drawings, he joked, “What are you doing, restocking the shelves?” The technician replied, “No. These are for you.”
Family members, including Naomi and the Klines’ son, Zachary, were tested, but no matches were found. Meanwhile, Dave endured exhaustion and more bouts of encephalopathy.
“I’ll tell you what, it was the worst Christmas I ever had,” Wanda said.
In February 2018, a board of doctors at UPMC Pittsburgh approved Kline’s case for a living donor transplant.
“The outcomes for living-donor liver transplant recipients are better than deceased donor given the recipient goes to transplant at a healthier state,” Ganesh said. “Living-donor recipients tend to also live longer because they’re typically healthier going into surgery than those who come to the top of the waiting list.”
“You don’t want to wait until he’s much sicker,” Wanda said. “So living donors are so important.”
Surprisingly, two weeks later the transplant coordinator called. Too choked up to speak, Kline handed the phone to Naomi, who then texted Wanda.
“I was sitting at break with friends at Bucknell, and I got a text that was nothing but exclamation marks,” Wanda said. “I texted back, ‘What?’”
Naomi quickly called to say, “We have a donor!”
Surgery is tentatively scheduled for May 2.
In a living-donor liver transplant, doctors take a piece of the liver based on the weight of the recipient and the volume of the donor’s liver, Ganesh said.
“In an adult living-donor liver transplant, usually 60 percent of the donor’s liver is removed,” she said. “Because the liver regenerates, the regrowth of the liver cells in the remaining portion of the liver occurs in a short period of time for both the donor and recipient.”
Right now, Kline’s liver is working at about 20 to 25 percent. “I get tired quickly, and cold,” he said. Along with his family, he is counting the days until May 2.
As for the organ donor, the Klines will never know the person’s identity unless he or she chooses to reach out to them.
“Looking back, when I was 30 or 40 would I have been a living donor?” Wanda asked, noting the donor will have to take several weeks off work to recover. “It takes a special person to do it.”
“There is a huge unmet clinical need for living donors to save lives of recipients waiting on the wait list, which is currently over 13,500,” Ganesh said. “With around one in every five patients waiting for a deceased donor succumbing to their liver disease before making it to transplant, we are trying to close the gap through education and awareness of living donation as the first option, rather than the last resort.”
Asked what they would say to their donor, both Kline and Wanda fell silent for several moments, fighting emotions.
“A big thank-you,” Wanda said.
Kline added, “A good hug wouldn’t hurt.”