Tabitha Derryberry, 49, is no stranger to chronic medical conditions. She has lupus, an inflammatory disease in which the immune system attacks joints, organs, and the skin. And when she was 35, Derryberry learned that her kidneys were failing due to having Sjögren’s syndrome, an autoimmune disorder that attacks the body’s cells. With her kidney function at just 30%, Derryberry began a regimen of immunosuppressant medications to slow down the kidney failure and avoid dialysis.
Five years ago, however, those same immunosuppressants caused Derryberry to become seriously ill following a tick bite. A month after the bite, she found herself waking up on the bathroom floor in her Lexington, Tenn., home with her husband, Brad, looming over her. “He was in my face asking, ‘Why are you throwing up blood?’” she said. After rushing to the local hospital, Derryberry received six units of blood to replace what she’d lost due to bleeding esophageal varices.
‘I found my people’
Derryberry was referred to an organ transplant center, but it was only willing to consider her for a liver transplant – not for a kidney transplant, too. She then sought treatment at a different transplant center, which informed her that her estimated post-transplant survival (EPTS) score wasn’t high enough for a transplant. After 10 terrifying bleeding episodes similar to the one following her tick bite, Derryberry was advised by her kidney doctor to contact the UAB Comprehensive Transplant Institute (CTI).
“Thank God I did – I found my people,” Derryberry said. “They listened, they didn’t balk at me saying that I wanted both a liver and a kidney, and they talked to me about the course of action they would take.” Coming from a blue-collar family and being a rodeo mom of four, it didn’t hurt that, at her first appointment, UAB CTI surgeon Robert Cannon, M.D., walked in wearing scrubs and cowboy boots.
Derryberry’s care team was very proactive in optimizing her health during her nearly three years on the waitlist. “They implemented a different regimen and approach to care even before the transplant,” Derryberry said. “We had conversations that changed everything for me.” A year before her transplant, Derryberry underwent a procedure designed to stop the bleeds by relieving the pressure in her liver. “I didn’t have another bleed after that procedure,” she said.
The risk of rejection
To recognize friend from foe, the body’s immune system relies on human leukocyte antigens (HLA). An important factor in a successful transplant is tricking the body into believing that the donor organ is a friend and shouldn’t be rejected. To help match the donor and recipient and reduce the risk of rejection, the UAB CTI performs HLA antibody testing prior to transplantation. This testing is carried out by the CTI’s state-of-the-art Histocompatibility and Immunogenetics Lab.
The challenge in finding a donor match for Derryberry was the variety of antibodies in her system. “Every time she got a blood transfusion, she received a different HLA,” said Julie Houp, associate director of the Histocompatibility and Immunogenetics Lab. Every HLA created a new antibody, and every antibody increased her risk of rejection. “It was like a runaway train,” Houp added.
Derryberry put it more bluntly: “My chance of a match was 2%,” she said. “I was a unicorn.”
However, Houp was up for the challenge: “I know a few tricks,” she said. The best-case scenario in transplantation is to avoid all antibodies. “She had so many antibodies that we didn’t have that luxury,” Houp said of Derryberry, “so it became a question of whether we could tell which ones were the worst from all the antibodies she had.”
Identifying and avoiding the worst antibodies paved the way for Derryberry’s transplants – in the right order. “If the liver is transplanted first, it can absorb some of the antibodies without causing damage,” Houp said. “Once it soaks up the antibodies, it’s then possible to safely transplant the kidney.”
Finding a match
However, Houp still needed to find a donor match. A regular blood serum analysis couldn’t reveal the good antibodies from the bad, so Derryberry’s blood serum was diluted. “That allowed us to see which antibodies remained potent,” Houp said. “We were able to predict which antibodies we should avoid and which we should try to crossmatch.”
When Derryberry received her liver transplant on July 31, 2022, her new liver responded as Houp predicted. “Six to eight hours after, we saw a reduction in antibodies,” she said. “They were out of circulation and couldn’t damage the kidney.” The UAB CTI surgeons then transplanted Derryberry’s new kidney.
UAB’s Histocompatibility and Immunogenetics Lab plays an important role in the transplant process. In fact, 90% of its work is related to the UAB CTI, in part because HLA typing is required before a patient can be listed as a potential organ recipient. “There aren’t enough organs to go around, so we need to make sure we match the right organ to the right recipient, so it isn’t rejected,” Houp said.
Gratitude, and a pinky promise
Derryberry has kind words for every member of her care team, especially UAB CTI Transplant Coordinator Kim Rayner. “Without her, I would not have known the talents of every person who was involved in my transplant process,” she said. “She stayed on top of my labs and explained every test, every procedure, and how it may affect me. There was not one time that Kim did not pick up the phone and treat me like family. She is truly part of the Derryberry family circle.”
Derryberry holds the talented UAB doctors and nurses in high esteem, but she’s also grateful to those who worked tirelessly behind the scenes. “Julie Houp and her lab made it possible for me to receive a transplant,” she said. “Dr. (Vineeta) Kumar and her team made it possible for me to keep the transplant. Every department played a key role in my story, and I am forever grateful.”
Derryberry holds a special place in her heart for UAB CTI Director Jayme Locke, M.D., MPH, who told her that transplantation was her best shot. “I asked Dr. Locke if she was confident and she said ‘yes’, and I knew she meant it,” Derryberry said. “We sealed those words with a pinky promise that would change my life forever.”