Delima Page

Fundraiser for Propionic Acidemia Foundation (PAF) in memory of Lauren and in honour of Jenna

Help Aubrey reach her goal!

Goal:  $2500    Raised as of 11/12:   $1167

Aubrey, mom to Jenna and Lauren will run the Vancouver Fall Classic Half Marathon on Nov. 4th, 2018… at the same time as other PAF parents are running the NY Marathon!

We are fundraising for PAF, as our adult daughter Jenna continues to live with this disorder.  More research and funding arerequired to get closer to finding a cure!  We are optimistic that in Jenna’s lifetime, a cure will be found.

Jenna is now an adult.  She is turning 20 on November 18th!  She graduated high-school life skills and is transitioned to a program called Gateway To Adulthood (GTA).  Jenna’s metabolic status has been stable.  However, last year when Jenna turned 19 she suddenly had her first seizure.  It was a scary time for us as we didn’t understand why she developed epilepsy.  It was happening often.  With a metabolic crisis, we knew our protocol.  Yet, with seizures we had to be alert and constantly in Jenna’s presence, as it could happen at any time.

As with any “normal” teen, Jenna is longing for her independence and seeks the love of a boy.  She admits to being a romantic and wants her prince charming to come one day and sweep her off her feet!  Jenna is quite the fashionista, too.  She wants to (one day) start her own clothing line that she designed.  In her free time, she likes to create stories:  Love stories, to be exact.  She will ask her friends to act out her story. Like a boss director, Jenna knows what she wants and tells everyone their rolls!  We are extremely proud of our daughter.  Once a baby we thought we would not see to live past age of 3, is now a thriving adult and living a beautiful life.

Help us  reach our goal of raising $2500 for PAF!

Below are details of previous year’s fundraising results & photos:


This year marks the 8th year of the DELIMA family campaign in memory of Lauren.

Thank you for your continued support.

Love, the DELIMA Family

PAF sponsors research on propionic acidemia by minority students – Summer 2017

PAF sponsors research on propionic acidemia by minority students – Summer 2017

Last summer, Propionic Acidemia Foundation (PAF) established a collaboration with Dr. Patricia Schneider from the department of Biology at Queensborough Community College (QCC, Queens, New York) to sponsor a project on the impact of propionic acid in the incidence of autism in Propionic Acidemia (PA) affected individuals. The project was part of the research initiative “Bridges to the Baccaularate”, a National Institute of Health (NIH) funded project that provides resources for a summer research project for minority students. Designed and mentored by Dr. Marisa Cotrina, herself the mother of a PA child, this work investigated the incidence of autism in the propionic acidemia population and the validity of mouse models of autism to study the impact of propionic acid in brain. A unique asset of the project was the utilization of the data collected by the PAF PA International Patient Registry. The authors of the study are currently preparing a manuscript for publication of the results found.

At the end of the project, our student, Sindy Ferreiras, had the opportunity to present her research in the area of Neuroscience at the Annual Biomedical Research Conference for minority students (ABRCAMS) that took place in Phoenix, Arizona last November. Well done, Sindy!

PAF Awards grant for Dr. Oleg Shchelochkov and Dr. Charles P. Venditti for $32,912

PAF awarded a  $32,912 research grant to Oleg Shchelochkov, M.D. and Charles P. Venditti MD, PhD at National Human Genome Research Institute, National Institutes of Health  – 2018

“Diversion of Isoleucine and Valine Oxidative Pathway to Reduce the Propionogenic Load in Propionic Acidemia.”

Patients with propionic acidemia require lifelong protein restriction. In addition to taking a protein restricted diet, many propionic acidemia patients are also prescribed medical formulas. This dietary approach aims to decrease the intake of four amino acids that can become propionic acid. These four amino acids – isoleucine, valine, threonine, and methionine – are called essential, because they cannot be made in the human body and need to be supplied from foods. Too much protein intake creates a situation where excess can lead to a buildup of propionic acid in the body. On the other hand, limiting these four amino acids too much can lead to poor growth. Therefore, patients’ diets are optimized to minimize propionic acid production while encouraging good growth. We wonder whether it is possible to increase dietary protein intake while minimizing the risk of propionic acid buildup.

To answer this question, we are planning to do a series of experiments in zebrafish. Why use zebrafish? Zebrafish share significant similarity to humans in how they process propionic acid. In addition, zebrafish reproduce and mature quickly, which are very important qualities to help search for new drugs that could be used to treat propionic acidemia. Our zebrafish are kept in a special building where the animals are being cared for by a dedicated team that includes scientists, veterinarians, engineers, aquatic specialists, and many others. They check on fish and feed them several times a day, maintain fish tanks, and keep their water very clean.

This type of facility is unique and had enabled our studies of metabolic diseases in zebrafish. Our ongoing studies have shown that zebrafish affected by metabolic diseases have symptoms that are very similar to patients. Even with treatment, affected fish have difficulty growing, get tired easily, have poor appetites and sometimes perish before adulthood. Using special genomic tools, we are planning to change in how the fish processes protein to direct it away from becoming propionic acid. As we make these changes to the biochemical pathways of propionic acidemia zebrafish, we will be carefully watching how these treatments improve their growth, development, appetite and survival. These experiments will help us understand how we can potentially reduce propionic acid toxicity while helping patients achieve a less restrictive diet.

Interview with Joel Pardo  – Summer  2020

Can you tell me about yourself and how you became interested in science?

I was always interested in the sciences. I think ultimately what propelled me towards a career in science was my research experience at the University of California, San Diego. The mentorship I received from Dr. Joshua Bloomekatz helped me develop the ability to reason scientifically and appreciate the opportunities to grow professionally. I learned from him how to design experiments to answer important scientific questions. We often had lengthy discussions about the direction of my project. He helped me make sense of the collection of observations coming from different sources and nurtured my own independent thinking.In gaining an appreciation for his analytical method of thinking, I began to see myself as someday contributing to scientific thinking as a physician-scientist.

During your training at NIH, you worked on a project to find new treatments using zebrafish. What did you find exciting and challenging about studying zebrafish?

Most people are familiar with mice, which are often used in science to find and test new drugs. Working with mice requires a lot of work to have enough animals needed for an experiment. Zebrafish, on the other hand, can produce hundreds of offspring after one breeding cycle. Zebrafish lay eggs directly into water, which also makes it easier to study them soon after they hatch. Somewhat surprisingly,the zebrafish enzymes that handle propionic acid are very similar to the enzymes in humans. These two properties of zebrafish make them an exciting model to study a disease like propionic acidemia.

One of the most challenging parts of my research in zebrafish was their size. Zebrafish offspring are very small, measuring less than a quarter of an inch. I had to spend a lot of time looking at zebrafish under the microscope and learn how to move them around without hurting them. This can be difficult as these small animals are fragile at this young age.

Can you tell us about your PA project?

Earlier in my work, we were able to get zebrafish, which had mutations in the genes linked to propionic acidemia. I needed to understand what propionic acidemia does to zebrafish. We were able to show that propionic acidemia in zebrafish looks a lot like the disease we see in patients. Fish with propionic acidemia had poor appetite, did not grow well, and had difficulty moving. Using special genetic tools, we then attempted to change how zebrafish processed propionic acid and helped them survive longer. Our preliminary results are proving promising, but more work is still needed.

What are your plans after you complete your training at NIH?

The NIH postbac program is a full-time research award for students that have recently completed a bachelor’s degree and are considering a career in science or medicine. I was fortunate enough to join Dr. Charles Venditti’s lab 2 years ago to work on the zebrafish project under Dr. Oleg Shchelochkov. I thoroughly enjoyed my post-bac experience. Looking back on the past 2 years, I feel the lab, and in particular the mentorship of Dr. Shchelochkov, has facilitated and nurtured my growth as a future physician-scientist with roots in propionic acidemia research. In 2019 I applied to MD/PhD programs at several US universities. After having traveled to over half a dozen states and interviewing at many fantastic universities, I ultimately decided upon the physician-scientist training program at University of Minnesota. As I plan my transition to the program, I am currently looking for winter coats.


SIMD 2018

PAF Exhibits at the 40th Annual SIMD Meeting – March 11 -14, 2018,  San Diego, CA

Jill Chertow represented PAF and the PA Community at the 40th Annual Society of Inherited Metabolic Disorders (SIMD) on March 11-14th in San Diego, California.   PAF partnered with the National Urea Cycle Disorders Foundation (NUCDF) on our exhibit booth to educate providers about hyperammonemia. PAF’s goal was also to network with PAF clinicians and attract researchers to collaborate with PAF on studies for PA .   The meeting was a great opportunity to hear about new research in metabolic disorders, newborn screening updates and issues about access and cost of drug therapies. Elaina Jurecki, M.S., R.D. presented on “Protein Intake Recommendations for Propionic Acidemia in the Evidence-based SERN-GMDI  Management Guidelines.”  Nutrition guidelines continue to be a hot topic.  Interesting poster topics included the use of medical food, liver transplant, and anaplerotic therapy.

During the breaks and meals there was time to network with physicians, dietitians, researchers, medical food providers, advocacy groups, and industry.     There is hope for a number of potential new therapies in mRNA, gene therapy, enzyme replacement therapy and/or new medications for the first time.

Liver Transplantation for Propionic Acidemia: FAQ

Liver Transplantation for Propionic Acidemia:

Part 1 – Answers to Questions that Families May Have

James Squires, MD, MS

Dr. James Squires

Dr. Squires is a liver disease specialist at Children’s Hospital of Pittsburgh of UPMC and an assistant professor of pediatrics at the University of Pittsburgh School of Medicine.

Jodie M. Vento, MGC, LCGC

Jodie Vento is a genetic counselor and manager of the Center for Rare Disease Therapy at the Children’s Hospital of Pittsburgh of UPMC.

What can we expect that a liver transplant could do for our child?

Based on experience to date with liver transplants in children with Propionic Acidemia (PA),we can say that after a liver transplant,children are likely to have a substantially better quality of life and a dramatic reduction in metabolic crises. It’s important for families to understand, however, that liver transplantation is not a cure for PA. This is because the enzyme deficiency that causes PA exists throughout the body, not just in the liver.

The liver transplant serves as what we liver specialists call a bulk enzyme replacement, providing enough functional enzyme to minimize – if not eliminate –metabolic crises, which are the most severe complications of PA for affected children as well as one of the most frightening features of the disease for families.

Because complications related to PA may still occur following a transplant, there will be a continued need for your child to get follow-up care with one or more medical specialists.


Is there a minimum or “best” age for a child with PA to have a liver transplant?

There is no minimum or “best” age. At our center, the average age of a liver transplant for a child with PA is about seven years old, but we have performed transplants in children as young as one year old.

The best time to consider a liver transplant is while the symptoms of PA are still reasonably well controlled. There is also no minimum age for undergoing a pre-transplant evaluation or being placed on the transplant waiting list.

What should we consider when deciding where to take our child for a liver transplant evaluation?

The most important factor to consider is the experience of the surgical team performing liver transplants in patients with PA and other metabolic diseases. These patients have complex needs that are different from those of patients receiving liver transplants for other conditions.

The pediatric liver transplantation program at Children’s Hospital of Pittsburgh of UPMC was established in 1981 by world-renowned transplant surgeon Thomas E. Starzl, MD, PhD. Our t Director of Pediatric Transplantation, George Mazariegos, MD, FACS, pioneered liver transplantation for children with metabolic diseases in 2004. Since that time, Children’s Hospital has performed more than 330 liver transplants for children with metabolic disease,more than any other transplant center.

We’ve also performed more liver transplants in children than any other center in the United States and more living-donor transplants than any other pediatric center in the country. Our one-year survival rate for pediatric liver transplant patients is 98%, exceeding the national average of 95%, according to the Scientific Registry of Transplant Recipients, Jan. 2018 release.

In addition to our world-renowned and experienced liver transplant surgeons, our Center for Rare Disease Therapy includes international experts in the diagnosis and treatment of PA and other metabolic diseases.

How would we start the process of having our child evaluated for a liver transplant?

I can tell you how the process works here at Children’s Hospital of Pittsburgh of UPMC. It starts with a referral from your doctor or hospital requesting that we evaluate your child. We also receive self-referrals directly from interested families. We will ask the doctor or hospital, or both, to send us all of your child’s medical records.

We will look at the records carefully to help us understand your child’s medical history and current situation. This information helps our multidisciplinary team develop an individualized plan for your child’s evaluation visit. For example, if your child has recently had certain laboratory or imaging tests done, we won’t repeat those tests unless there’s a valid medical reason for doing so. Understanding how the disease is affecting your child helps us identify which specialists your child should see during the evaluation.

It’s important for families to know that undergoing a pre-transplant evaluation involves no commitment on either side. It carries no guarantee that your child will be listed for a transplant or, conversely, any requirement that you must agree to have your child placed on the transplant waiting list. We can answer questions, provide information, and make recommendations. Ultimately, however, the decision to proceed with a transplant, or not, is a personal one for each family to make.

The evaluation is an opportunity for the family and the health care team to meet and get to know each other, as well as for the family to gather information and get answers to any and all questions you may have. We hope you’ll feel comfortable raising any concerns. Please don’t hesitate to ask us about any issue that’s on your mind. There are no dumb or silly questions. And, of course, if after you’ve gone home you think of something that you wish you had asked, please give us a call.

You can expect that the evaluation will be a two- or three-day event. The staff of our Center for Rare Disease Therapy will work with you to arrange for you, your child, and other family members to stay near the hospital, either at our Ronald McDonald house or at a nearby hotel, while you’re here for the evaluation.

We’ll send you a schedule in advance of your visit. This will tell you which medical and surgical specialists you’ll be seeing at what times and what laboratory or imaging tests we would like your child to have during the evaluation. To the extent possible, we try to anticipate all the testing we’ll need so that it’s a relatively smooth process while you’re here.

Please tell us more about what we can expect during our child’s evaluation.

Because PA is a genetic disease, the specialists you’ll see will likely include a medical geneticist and a metabolic dietician. Also, because PA often causes heart problems, your child’s evaluation is likely to include basic heart function tests and an assessment by a cardiologist. Depending on how the disease is affecting your child, the evaluation may also include visits with specialists such as the following:

  •         A neurologist, to assess brain function
  •         A gastroenterologist, to assess pancreas function
  •         A hematologist, to assess bone marrow function

Although we try to anticipate all the testing we’ll need and schedule it in advance, sometimes we may decide that it would be helpful to do an additional test that wasn’t originally on the schedule. For example, depending on the results of the basic heart function tests, the cardiologist might want to do a “stress test” that will provide more detailed information and measurements relating to how well your child’s heart is functioning.


If we decide to go ahead with listing our child for a transplant, what are our options for obtaining a donor liver? How long can we expect it to take to find a compatible donor?

PA is considered a high-priority condition for liver transplantation, so your child’s name will be near the top of the waiting list. However, because demand for donor livers is high and supply is limited, I tell families to be prepared to be on the waiting list for several months.

With any liver transplant, careful testing needs to be done to ensure compatibility of the donor liver and the transplant recipient.Many factors can influence the waiting time for a compatible organ. For example, a child with an uncommon blood type may face a longer wait.

In general, child-size donor livers are scarce. A unique feature of the liver, however, is that it is the only organ in the human body that can regrow. This means that in some cases it’s possible to transplant a section of a healthy liver rather than the whole organ. For example, a child who needs a liver transplant may receive a section of a liver from an adult donor. You may hear this type of transplant referred to as a “reduced-size” or “split” liver transplant.

Another type of liver transplant involves a living person – such as a relative, friend, or even a stranger – donating a section of their liver to someone who needs a transplant. Living-donor transplants may be an option for some children with PA. However, because PA is a genetic disease, parents and possibly siblings may be carriers of one of the genetic defects that cause the disease. Someone who is a carrier would not be a suitable living donor.

The good news is that children who receive a partial liver seem to do just as well as those who receive a whole liver. All of the options for obtaining a donor liver, including a reduced-size, split, or living-donor transplant, are discussed during the pre-transplant evaluation.

We’ve decided that a liver transplant is right for our child. What are the next steps?

When your child’s name is placed on the liver transplant waiting list, we will give you a pager that you will need to take with you everywhere you go so that we can reach you right away when we get a call that a matching donor liver is available. We don’t know when that call will come, but when it does you’ll need to be able to get to Children’s Hospital in a safe, but timely fashion. The transplant team will work with you to establish a ‘travel plan’ for you and your family for when the transplant is likely to occur.

While your child is on the waiting list, our specialists will work with your local doctors to care for your child and optimize their medical condition ahead of the transplant.

We know that waiting can be a difficult time for families. Your transplant coordinator is always available to respond to your questions and concerns and can also help you make travel arrangements.

Once you arrive at the hospital, preparations for the transplant may take from 12 to 24 hours. Your child will undergo another round of tests to confirm that the donor liver is a good match. Your child will also need to fast before surgery. Our metabolic dieticians will help us prepare intravenous fluids to provide your child with an individualized balance of fats, protein, and glucose to maintain stability while they can’t take anything by mouth.

The liver transplantation surgery may take up to several hours, although this varies in each case. While your child is in the operating room, a member of the transplant team will keep you informed on the progress of the transplant.

After the surgery, your child will go to the intensive care unit to be monitored closely until their condition is stable. Then your child will be moved to the liver transplant unit. Staff here will help you learn about your child’s medications, diet, need for follow-up care, and anything else you’ll need to know to care for your child.

After the transplant, will our child have to take anti-rejection medication?

After a liver transplant, you should expect that your child will need to take medication for the rest of his or her life to prevent organ rejection. The body’s normal reaction to a transplanted organ is to recognize it as a “foreign agent” and mount an immune response against the new liver. Anti-rejection medications suppress the immune system, which is the body’s defense system against illness and infection, to prevent it from attacking the new liver.

Because anti-rejection medications weaken the immune system, your child may be more likely to get infections – and those infections will be harder to treat. You will need to notify the transplant team at the first sign of an infection, such as a fever, chills, sweats, coughing, nasal congestion, diarrhea, redness or swelling, pain, or vomiting. A referral to a doctor may be needed as well.

With immune-suppressing medications, the goal is to find a treatment plan that achieves the needed degree of immune suppression while causing the fewest and least harmful side effects. Regular blood tests will help your child’s doctors monitor the medications’ effectiveness.

The risk of organ rejection declines over time. This means that in time your child should be able to take lower doses of anti-rejection medications. Most likely, however, he or she will need to continue taking at least a low dose of immune-suppressing medication lifelong.

Here at Children’s Hospital of Pittsburgh of UPMC and elsewhere, research is underway to learn more about whether some liver transplants patients can eventually stop taking immune-suppressing medication without increasing their risk for rejection of the transplanted organ. This research is a long-term effort, however, and it will be years before we can answer this question.

For more information, please visit: or call (412) 692-RARE (7273)

In Part 2 of this article, Dr. Squires will summarize the findings of a recent study of outcomes in children with PA and methylmalonic acidemia who received liver transplants at Children’s Hospital of Pittsburgh of UPMC.

2017 Warrior Wisdom Conference Welcome


The Propionic Acidemia Foundation invites you to join us at the 2017 Warrior Wisdom Conference in Deerfield, Illinois to be held at the Hyatt Regency Deerfield from June 8th – 10th, 2017.  You will hear from physicians and researchers about propionic acidemia and have the opportunity to learn more in small breakout sessions of your choice. Take this opportunity to learn about current studies on propionic acidemia and how you can participate and move us forward in finding better treatments and cure.  As always, there will be ample time for networking.   Children will have fun with our volunteers and make new friends.   Healthcare providers and researchers will have the opportunity to learn more about PA and meet the families they are striving to help.

For sponsorship information e-mail [email protected]

A Heart Felt Thank You to our Conference Sponsors

Platinum Sponsors 

School Chest Head purple   Nutricia Logo

Gold Sponsor

Recordati Rare Diseases

Silver Sponsor

Cambrooke Therapeutics

Supporting Sponsors


PKU LogoMevalia Logo


Jazmin G. Jazmin

There are four children in our family, ages 16, 14, and our 6-year-old twins. Jazmin is 6, she was born on 1st July, 2012. She became ill for the first time in March 2016, she caught a cold.  She got gradually worse: vomiting, somnolence, and because of not being treated well enough, our daughter fell into coma. As a result of the hospital examination, Encephalitis viralis was diagnosed. Jazmin was examined for different viruses and metabolic diseases. The sample taken from the spinal cord was negative. After that she recovered without no further treatment.

Jazmin is fine now, developing well with 19 grams of daily protein intake. She eats by the mouth. She does not attend kindergarden yet, but she is really looking forward to it.

Partners in Progress: Families and Scientists Catalyze Research for Rare Diseases

“Partners in Progress:  Families and Scientists Catalyze Research for Rare Diseases”

On Nov. 15, 2017, Baylor College of Medicine and Texas Children’s Hospital hosted a panel discussion as part of theEvenings with Genetics seminar series held at the Children’s Museum of Houston. The topic was “Partners in Progress:  Families and Scientists Catalyze Research for Rare Diseases” and panelists traveled from both coasts and the center of the country. Panelists included Jill Chertow Franks, President, Propionic Acidemia Foundation; Cynthia Le Mons, Executive Director of the National Urea Cycle Disorder Foundation, Tracy Smith Hart, Chief Executive Officer, Osteogenesis Imperfecta Foundation and Brendan Lee, MD, PhD, Robert and Janice McNair Endowed Chair, Professor, Department of Molecular and Human Genetics, Baylor College of Medicine. These family/scientist partnerships are a new and exciting development in the research efforts for those impacted by rare diseases.

The audience of almost 80 people consisted of parent leaders, rare disease foundations, medical students, genetic counseling students, pharmaceutical companies and undergraduate biotech majors. Each panelist discussed the partnerships with rare disease organizations and scientists and their strategies for success in obtaining funding for research from the National Institutes of Health (NIH). In addition, panelists shared how they became involved in the rare disease organization and offered advice for other rare disease organizations as well as researchers with regards to working together to submit requests for funding. Dr. Brendan Lee discussed the positive impact of family/scientist partnerships and that these collaborations highly beneficial for progress in understanding rare disorders and developing effective therapies.

Susan D. Fernbach, RN, BSN

Director of Genetic Outreach

Director of Diversity and Community Engagement

Assistant Professor, Dept. Molecular and Human Genetics

Baylor College of Medicine/Texas Children’s Hospital

Annabelle’s Transplant

Annabelle’s Transplant

Annabelle Grace was born September 20, 2016 and like many children with Propionic Acidemia (PA) she went Annabelle Birthinto metabolic crisis a couple of days after birth.  After talking to our genetics team in December 2016 we started pursing the option of a liver transplant for Annabelle.  Even though we managed Annabelle’s care so meticulously she would still end up in the hospital every couple of months for high ammonia levels above 100 (often for no reason and with no detected illness).  Annabelle had a g-tube placed when she was two weeks old, but even with pushing fluids and using sick day formulas we found it difficult to keep her metabolically stable (we checked her ketones EVERYDAY). We tried Carbaglu (which is supposed to help lower ammonia) along with high doses of Carnitine and Bicitra (Sodium Citrate), and those medications didn’t even seem to help control her metabolic instability. Her ammonia on a “good day” seemed to hover inthe 60’s or 70’s, and even the night before her transplant her ammonia was 71. We realized early on that Annabelle had a very severe mutation, and we were told by many medical professionals that she was one bad illness away from another metabolic crisis that could cause serious brain damage.

After talking with other families we were told that the Children’s Hospital of Pittsburgh was the place to go for transplant. The only liver transplant option in our state (North Carolina) was Duke University, but they had never performed a liver transplant on a child with PA.  In April 2017 we ventured up to Pittsburgh, PA for Annabelle’s liver transplant evaluation and immediately fell in love with everything this hospital had to offer.  Annabelle was officially listed for transplant on May 2, 2017.  We immediately started fundraising and used the assistance of COTA (Children’s Organ Transplant Association) which we cannot recommend enough.  Within three months our team of volunteers raised over $50,000 for COTA in Honor of Annabelle to help with any transplant-related expenses.

On August 9, 2017 we got “the call” that would forever change our lives, and we quickly rushed to Pittsburgh.  We Annabellewere very fortunate that our first call was “the call” that gave Annabelle her new liver.  She went back for surgery around 10:30pm that night and they finished her surgery around 9am that next morning.  After surgery Annabelle spent about one week in the PICU. After that week the transplant team moved herto the transplant recovery unit where she stayed until she was discharged.  Around two weeks post-transplant Annabelle did encounter a small episode of rejection.  Even though “rejection” sounds scary it is very common early on in transplant, and mild cases like Annabelle’s are generally treated with some high-powered IV steroids for a few days.  Annabelle was discharged on August 30th and only spent a total of 21 days in the hospital. The transplant/genetics teams in Pittsburgh told us to prepare for complications (as is common with Organic Acidemia patients), but overall Annabelle had very few complications from her transplant surgery for which we are thankful.

After getting discharged we were required to stay in the Pittsburgh area until the transplant team decided she was stable enough to return home to North Carolina.  Luckily, the Ronald McDonald House there is amazing, and instead of hotel rooms they have small one-bedroom apartments making it possible to live there for an extended period of time.  Plus, it is one of the few Ronald McDonald Houses where it is connected to the hospital, so even when Annabelle was inpatient we were able to easily access their services (homemade meals, laundry, therapy pets, etc.).   We stayed in Pittsburgh until late November mainly going to the hospital for weekly labs, therapies, and clinic visits.  The team had to keep changing her medications weekly so that her liver numbers and her EBV levels (Epstein-Barr Virus that she acquired from her donor) maintained a healthy balance.   Our total stay in Pittsburgh was a little over three months, which we were prepared for since the transplant team told us prior to surgery to expect to stay there anywhere from three to six months depending on the amount of complications.

Since we’ve been home it has been a bumpy road.  The transplant team told us that the first winter post-transplant is always very difficult and they were right! Annabelle has been living in a bubble all winter, but she has still been in and out of the hospital the past few months due to illnesses from her immunosuppression.  When we do have to go to the hospital its more for treating the illness caused from her immunosuppression rather than treating her underlying metabolic disorder. When you get a liver transplant it really is just trading out one disease (PA) for the other (transplant) in hopes that treating the transplant gets easier in time.

Even though the liver transplant brings a whole new set of issues (more frequent bloodwork, more meds, life-long Annabelle January 2018immunosuppression), we know that Annabelle is more metabolically stable on a day-to-day basis. Even when she does get sick we don’t worry as much about the significant possibility of brain damage because her ammonia levels stay within the normal range or are only slightly elevated.  The highest her ammonia has gotten post-transplant has been 98 (from frequent vomiting), and her new normal on a “good day” now averages in the 30’s.  It’s also been amazing to see the developmental progress she’s been making post-transplant.  She’s so much more alert, and her overall energy level and muscle tone have increased greatly.

Since Annabelle’s transplant we have been able to come off of Carbaglu and Bicitra, but she is still receiving Carnitine (which we were told she’ll be on for the rest of her life). Her feeding skills are still lacking, and getting her to eat by mouth is still a struggle. However, she’s getting feeding therapy and making progress so we are hopeful that she’ll eventually eat enough food by mouth to come off of her formula.  Her protein intake can be less restricted now, but since she’s primarily tube fed her metabolic dietician has been conservative (1.3g/kg) and hasn’t tried to push her protein as long as her amino acids stay within the normal range.  The main food advantage post-transplant is that we don’t have to weigh her solid foods now and we just go by the nutrition label.  Also, if she throws up we don’t have to immediately pump more formula back in her; now we just let it go unless the vomiting becomes excessive.   There’s a lot more wiggle room in her overall stability,and we aren’t “living on the edge” every single day like we were pre-transplant.

We know the decision to transplant your child is a difficult one, and we’re very open to discussing our journey with any families that would like to speak with us.  Please feel free to see more about our journey at where you’ll be able to find our blog posts, as well as, a link to Annabelle’s Facebook Page where you can see photos and videos from our transplant journey.

Sincerely,Annabelle's Family May 2017

Mike, Charity, and Annabelle