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David Barresi describes 2022 as one of the most fateful years of his life. In June, he found out that his wife was pregnant with the couple’s first child. Then, in August, he learned that his previous kidney transplant was failing. Soon, he’d need a second transplant. How, he wondered, would he be able to prepare for fatherhood, given the challenges of finding a donor, undergoing transplant surgery and recovering from the procedure?��

Fast forward: David reports that his new transplanted kidney has given him a “new lease on life.” But his journey to that most welcome of outcomes has been anything but smooth. I��’s a journey that began before he was born.��

A common birth defect��

As an infant, David cried nonstop, his parents recall. They took him from doctor to doctor, but none of them could figure out what was wrong. It wasn’t colic, and it wasn’t an ear infection. “I was misdiagnosed over and over,” he says, until specialists at a children’s hospital identified a two-fold problem.��

David had come into this world with a severely atrophied kidney, caused by a condition called vesicoureteral reflux (VUR). That condition made his urine flow backwards from his bladder to his kidneys, resulting in permanent damage to one kidney.����

Normally, urine flows in one direction—from the kidneys through the ureters to the bladder, says Dr. Thangamani Muthukumar, an Associate Professor of Medicine, Associate Director of the Nephrology Fellowship Program and a practicing nephrologist at �鶹��ý�����. “I��’s usually a one-way street. There’s a valve-like mechanism that prevents urine from flowing in the wrong direction, back up to the kidneys. But with VUR, that valve-like system goes awry.��

“The sheer speed with which the urine flows in the wrong direction ends up damaging the kidneys,” he continues. “VUR also sends bacteria up through the urinary system, leading to recurrent kidney infections.”��

At just 18 months old, David had surgery at the aforementioned children’s hospital to repair his faulty “valves.” That bought him time.��

Transplant number one��

For the duration of his childhood into early adulthood, he was monitored closely by a nephrologist in New Jersey. The goal was to keep as much kidney function as possible. But��

in his early 20s, David developed worsening symptoms related to kidney failure, including lethargy, weight loss and a dramatic loss of energy that interfered with his college studies.����

He went on dialysis for a period of 5 years—a temporary fix—a�Ի� he underwent transplant surgery in 2010, thanks to a genetically unrelated living donor. However, his body rejected the new kidney not once but twice before it finally “took.”��

That kidney’s benefits lasted for the next 12 years. But soon, those all-too-familiar symptoms started to return. “Every day felt like a battle,” he says. “I lost 50 pounds, and I lost a lot of muscle.” But this time, he decided to travel from his home in Bucks County, Pennsylvania to New York City, where he was seen by Dr. Muthukumar (Dr. Muthu for short)—a�Ի� that, David says, has made all the difference.����

The art and science of personalized care��

David credits Dr. Muthu for prolonging the life of his first transplant. However, the trusted nephrologist insists that there was no magic involved. It was and continues to be all about personalizing care and close monitoring.��

“I kept a close eye on �ٲ�������’s risk factors, fine-tuning his immunosuppressive medications and controlling his blood pressure. This is all routine care. Tha��’s the science part. What makes it an art is the subjective element.”��

Asked how he knew when the time had come for a second transplant, Dr. Muthu cited two main factors: �ٲ�������’s worsening kidney function—a quantifiable percentage—a�Ի� his symptoms. He advised David to start looking for a living donor, a process that didn’t take long, thankfully.������

Transplant number two��

�ٲ�������’s best friend Sean stepped forward, and he turned out to be an excellent, fully compatible candidate. David describes Sean as a “down-to-earth, cool guy—someone I can be totally real wit��.” Sean’s life-saving donation has strengthened their friendship, helping to forge a lifelong bond between the two men.����

�ٲ�������’s daughter Mira was born at the end of February 2023, and his transplant surgery took place 3 days later. “I was there for my daughter’s birth, thanks to FaceTime.” He was discharged from the hospital on Valentine’s Day, and tha��’s when he saw his daughter in person for the first time. “I was shocked to see how small she was!”��

Benefits and challenges��

Asked what life is like for him now, he says i��’s a “complete reversal. I’m enjoying food, work and family life in ways I couldn’t have imagined a year ������.”��

David was able to take 3 months’ medical leave, during which he helped to take care of his baby daughter and build up his strength.��

He continues to come to New York for periodic check-ups with Dr. Muthu, along with his transplant surgeon, Dr. Sandip Kapur, Chief of Transplant Surgery and Director of �鶹��ý�����’s Kidney and Pancreas Transplant Program. The two specialists work collaboratively with a dedicated team that includes pharmacists, advanced practice providers and others too numerous to mention, treating patients in the same clinical setting. Says Dr. Muthu, “I was at �ٲ�������’s bedside right before his transplant and immediately after. And I’ve been monitoring his progress ever since. He’s doing great!”����

David agrees. “The doctors and other health-care professionals at �鶹��ý����� are masters of their craft, and the level of care is the best I’ve ever experienced.”��

Not that there aren’t challenges, David says—the main one being the immunosuppressive medications he’ll need to take for the rest of his life to prevent his body from rejecting his transplanted kidney. Immunosuppression leaves transplant patients vulnerable to all manner of infections. David was recently hospitalized with pneumonia, but he came through it in one piece, and he has been flourishing ever since.��

“The other challenge,” he says, “has to do with balancing my responsibilities at work and at home. Tha��’s true of any working parent. I��’s rewarding, though, to be able to take care of my daughter. I’m also taking care of my health by staying on top of my medications and coming into the city for my appointments with Dr. Muthukumar.” Tha��’s something he’ll do as long as his second transplant lasts, which should be for many years to come.��

Make an appointment with a nephrologist at �鶹��ý����� here.����

To learn more about �鶹��ý�����’s Kidney and Pancreas Transplant Program or to consult with a surgeon, please  visit this��website ��or call 212-746-3099.��