Harris Cander

Alan and Harris Cander were close growing up. Alan, two years older, was good at sharing. He not only shared his toys, but taught his younger sibling, Harris, how to appreciate music, speak using proper grammar and excel academically. After childhood, Alan's legacy of sharing didn't stop. He continued to share political views and movie reviews ... and, when a congenital kidney disease threatened Harris' life, Alan also shared one his kidneys with his younger brother.

"When we were young, Alan and I would improvise duets on the piano," remembers Harris Cander, Ph.D., a geochemist for BP in Houston, Texas. "He was always better than I was, so eventually I quit piano and took up the guitar." But this move was very atypical of Harris, who when faced with a life-threatening disease, wouldn't quit until he explored every option for life — and won.

A common inherited disorder

As a young adult, Harris had developed a healthy lifestyle. At 25, he was a non-smoker who exercised regularly, ate a balanced diet and maintained a healthy weight. That why when he developed hypertension or high blood pressure, both Harris and his father knew something didn't add up.

"My father was a pulmonary specialist who practiced in internal medicine and family medicine," says Harris. He knew there was a strong correlation between hypertension and renal function, so he urged me to have a complete medical evaluation."

Harris learned that he was born with autosomal dominant polycystic kidney disease — or ADPKD — the most common inherited disease caused by abnormal genes.

It affects between one in 400 to 1,000 individuals in the United States and, after diabetes mellitus and hypertension, is the most common single cause of end stage renal disease. Approximately 1,800 people with ADPKD need to start dialysis or receive a kidney transplant each year in the United States.

In the past, ADPKD was called adult polycystic kidney disease, because symptoms of it often develop between ages 30 and 40. However, a small number of children do develop the disorder. Only one parent needs to have the disease in order for it to be passed along to children. If one parent has ADPKD, each child has a 50 percent chance of getting the disease. While inherited ADPKD accounts for about 90% of the cases, in Harris' case, the disease was a spontaneous genetic mutation, meaning neither parent had the disorder, but he received it by a fluke of nature.

Polycystic kidney disease is named such because it causes clusters of noncancerous (benign) cysts to develop in the kidneys. The cysts are round sacs that contain water-like fluid. They vary in size from tiny sacs to sacs large enough to hold several quarts of fluid. The disease isn't limited to only the kidneys, although they are usually the most severely affected organs. Kidney failure is common for those with polycystic kidney disease.

Being dealt a card

"Polycystic kidney disease usually progresses slowly over time," says James Gloor, M.D., a nephrologist in Mayo Clinic's Transplant Center in Rochester. "For most patients with the disease, eventually it results in renal failure, in which dialysis or a transplant are the patient's only options," says Dr. Gloor. "Patients with polycystic kidney disease are closely monitored for decreased creatinine clearance in the blood — which decreases as renal function decreases," explains Dr. Gloor.

"After my initial diagnosis, I began mapping my creatinine clearance results through my ongoing blood tests," says Harris. "The number started at over 100 shortly after my diagnosis and was at 27 before I was put on the transplant list At the time of my transplant, my number was below 15."

"When creatinine clearance is around 15, the patient is usually in end-stage renal failure," says Dr. Gloor. "Harris was nearing the point where he might require dialysis."

"I didn't ask for this disease or obtain it through bad behavior or unhealthy habits," says Harris. "I was dealt a card and had to figure out how to play it." The mental stress on Harris was significant. "For 20 years, I knew I had an incurable, unstoppable disease that was slowly deteriorating my kidneys," he says. "I carefully charted my creatinine clearance and could literally predict the approximate year that I would reach renal failure."

Harris wasn't willing to wait until he went into renal failure. He knew that in the United Sates, 90,000 people are in need of a life-saving transplant — and each day 100 people are added to the list. Harris became very proactive in learning more about his disease and his options for treatment. "I started doing some research and was very interested in the living donor option," says Harris. "Fortunately, my sharing-minded brother was willing to donate one of his healthy kidneys."

Unfortunately, Alan's was not a match in terms of blood type, which is called "ABO blood group incompatible." In addition, Harris was sensitized against Alan's blood type, meaning he would develop antibodies against Alan's kidney. This is referred to as a "positive crossmatch."

These were two more cards that Harris was dealt. "I found out that nearly all transplant programs would say that a kidney from my brother wasn't an option for me," says Harris. "But after hours of research, I learned about innovative techniques in ABO incompatible and positive crossmatch kidney transplants at Mayo Clinic in Rochester and decided to schedule an appointment."

"I was driven by a strong will to live to see my three-year-old daughter, Sasha, grow," recalls Harris. "In addition, my wife Chris was pregnant with our second child. I had so many wonderful reasons to live."

Leading-edge treatment and research

"Mayo Clinic is one of very few centers nationwide that has pioneered and performs ABO incompatible and positive crossmatch transplants," says Dr. Gloor. "However, we've done about 200 of them since 2000 with success rates similar to cadaveric kidney transplants.

Advancements in transplantation medicine have led to many innovative therapies for difficult-to-treat medical conditions. At Mayo Clinic, pioneering research gives patients the opportunity to participate in the clinical use of new techniques, drugs and technology. Most importantly, for Harris Cander, it gave him the option of having an ABO incompatible and positive crossmatch transplant from a living donor before his own kidneys failed.

"Living donor kidney transplants doubled over the past decade," says Dr. Gloor. "A living donor kidney remains viable about 10 years longer than a cadeveric kidney, often eliminating the need for a subsequent transplant in younger patients."

"When we arrived at Mayo Clinic for the transplant, my wife Chris was about eight months pregnant," recalls Harris. "She arranged to have her OB treatment here and we were prepared in case she needed to deliver our baby in Rochester."

Harris and Alan — in keeping with their childhood — shared a pre-op room. "Alan was on one operating table and I was on the other," recalls Harris. "We went into surgery together."

"Before and after the transplant, the patient undergoes a procedure called plasmapheresis," explains Dr. Gloor. "During this procedure, one IV line draws out the patient's blood and separates the red blood cells from the plasma through centrifuge or a cell separator. After the plasma is discarded, antibody-free plasma, which comes from donors, is re-inserted."

Harris underwent four plasmapheresis sessions prior to surgery and ten sessions post-transplant. "The sessions were painless ... nearly effortless and the nursing staff was exceptional," recalls Harris.

Currently, Mayo Clinic is actively pursuing research projects to understand the genetic, biochemical and cellular analysis of polycystic kidney disease (PKD), including the mutational mechanism of the two genes that cause ADPKD. A major focus of the research is to characterize mutations that lead to these disorders and correlate them to the disease presentation and progression, so that treatments, other than kidney transplant, can be developed.

A winning hand

Alan left Rochester a few days after donating his kidney. Harris remained in Rochester for a month before returning to Houston. Two weeks after their return, Chris gave birth to their son, Joshua.

Both Alan and Harris are doing wonderfully. Harris returned to his job with BP four weeks after surgery, exploring for natural gas in North America — and to his main hobby, enjoying quality time with his family.

Harris has developed an informational lecture about his experience and the availability of ABO incompatible and positive cross-match organ transplants. "I am surprised at the number of people who don't know about this option," says Harris.

"I was raised by a father who was a doctor and mother who is a nurse. I've had shoulder reconstruction, hand surgery, several knee operations, and an emergency appendectomy," says Harris. "I saw a doctor on a regular basis for 20 years after my diagnosis, so I have a great deal of experience with various medical providers. Nothing in my life compares to the experience I had at Mayo Clinic. At the risk of sounding utopian, 'everything is for the benefit of the patient.'"

Finally, Harris Cander has picked up a winning hand.