Amputee is in line for double transplant

Jeff Kepner knew as soon as he opened his eyes that he would lose his hands.

"I came out of the coma, my hands and feet were black, like frostbite," he said nearly 10 years later. "It was like gangrene, frostbitten, my fingers were curled up and ... they told me."

A massive infection caused blood to be cut off from his hands and feet, withering his limbs. But he soon might regain hands.

Mr. Kepner, 57, could become the first double hand transplant patient in the U.S. through a program at the University of Pittsburgh Medical Center. There have been 11 such cases worldwide, mostly in Europe and in Asia, according to the International Registry on Hand and Composite Tissue Transplantation. There have been five single hand transplants in the U.S. and more than 20 worldwide.

Mr. Kepner would also be the first hand transplant recipient to undergo a new immunosuppressant protocol. It replaces the traditional three drugs (and their serious side effects) with a bone marrow transplant and a single drug with potentially fewer complications, surgeons at the Pittsburgh center said.

For Mr. Kepner, it's a chance to regain parts of his life that he lost after May 1999, when he nearly died.

He will never know where he picked up the group A streptococcus bacteria, which can cause mild infections such as impetigo or skin rash or invade the bloodstream and turn deadly.

It started as a fever, and Mr. Kepner just thought it was the flu.

"That's all I had was a fever," he said. But after three or four days of 102-degree fever he began to feel worse and called Medical College of Georgia Hospital and Clinics, where he was told to come to the Emergency Department.

"That's the last thing I remember for three weeks," he said.

His blood pressure had dropped to 80 over 40, and he was taken up to the Intensive Care Unit and scheduled for surgery, said Valarie Kepner, Jeff's wife.

"They thought it was his gallbladder," she said.

Mrs. Kepner was told to go home and come back the next day, which was a Sunday.

"And I came back on Sunday, and I walked in, and I didn't even recognize him," she said. "He was gray; his head was swollen."

She was called down to a conference room by surgeon Karen Yeh, who had been covering the ER when Mr. Kepner came in.

"She just put it right out there on the table," Mrs. Kepner said. "She said, 'I have to tell you, Valarie, I don't think he is going to make it through the night.' And they were right; it was three times that we lost him."

He would crash, only to be revived again.

The Kepners credit Dr. Yeh and two of her residents at the time, Dr. Allen P. Butler and Dr. Charles A. "Drew" Bagwell, with saving his life.

"One of them was always at the hospital," Mrs. Kepner said. "His kidneys shut down; his liver shut down."

"I was dead," Mr. Kepner said. "They had me dead."

Having just moved to Augusta from Pennsylvania, Mrs. Kepner began summoning family members from across the country.

"It was the biggest family reunion ever, and I missed it," Mr. Kepner joked.

The infection caused toxic shock syndrome in his body and shut down organs. Those developing toxic shock from that type of infection died in 44 percent of the cases studied in Europe, according to an article last year in the Journal of Clinical Microbiology .

A full-body CT scan finally showed a massive sac of fluid around his liver, and a sample from that confirmed his diagnosis. Heavy doses of antibiotics and steroids over the next three weeks saved his life.

But as his body was fighting the infection, it was drawing his blood to his organs and the central body cavity at the expense of his limbs. After a while, the hands and feet curled up and shriveled.

"I lost my limbs in order to save my life, basically," Mr. Kepner said.

"It's funny how the body does that," Mrs. Kepner said.

He looks puzzled, however, when he is asked why he thinks he survived.

"I would have to say my faith," Mr. Kepner said. "We had so many people praying for us."

"I think there is a reason," Mrs. Kepner said.

"I didn't die for a reason," Mr. Kepner added. "I wish I knew what it was."

'Maybe that's why'

Months of difficult rehabilitation followed, and prosthetics allowed him to walk again, feed himself, even drive a modified truck and return to work at Borders bookstore.

He takes his 13-year-old daughter, Jordan, back and forth to school and helps her with her homework. With his wife's help getting into his shower legs, and later helping put covering over his limbs and attaching his prosthetics, he can lead a fairly independent life.

It is a point he likes to make when he visits more recent amputees at the Augusta Department of Veterans Affairs Medical Centers, some of them active military personnel just returning from Afghanistan or Iraq.

"These kids who come back from Iraq with lost limbs, I'll go over and talk to them," Mr. Kepner said. "But most of the time when I walk in they'll go, 'Ohhh, I'm not near as bad as you are.' And I can see it in their eyes when I walk in. They kind of perk up."

It happens a lot, actually.

"People would walk up and say, 'You know, I felt sorry for myself when I walked in here today. But you know what; I totally have a different outlook after seeing you,' " Mrs. Kepner said.

"Maybe that's why I'm here," Mr. Kepner joked.

Still, Mrs. Kepner was intrigued when she saw a story about the Pittsburgh hand transplant program and called the medical center right away.

"I didn't call him; I called them," she said, laughing.

Her timing could not have been better: The transplant team was getting ready to meet two hours later, and the woman assured her she would present Mr. Kepner's case.

Mrs. Kepner got a call back that afternoon from one of the transplant surgeons.

What followed were three trips to Pittsburgh and a battery of grueling tests and interviews, which wrapped up in January. Mr. Kepner is the first to complete the screening, and now the search is on for a suitable donor.

"I've got nothing to lose. Absolutely nothing to lose. I already know how to use these," he said as he held up his prostheses. So if it doesn't take, "you can cut them back off, and I'm good to go."

'Able to touch'

After a career in the Air Force, where he and his wife met, Mr. Kepner worked for several years on a culinary degree, finally graduating in 1998. It's a skill he barely got to use before his illness.

"I was a pastry chef," he said. "I'll be able to get back to baking."

It's not being able to do the smallest things that frustrates him at times.

"It's maddening to sit here and see a light bulb go out and know you can't replace it," Mr. Kepner said. And there are things that no prostheses can do that a hand can.

"Being able to feel again," he said. "I'll be able to touch things."

"Jordan doesn't remember holding hands with him," Mrs. Kepner said. "She was 3 when this happened."

And that is why a hand transplant is an improvement, said surgeon Vijay Gorantla, the administrative director for the Pittsburgh Composite Tissue Allotransplantation program.

"Hand transplants are different because they provide sensation," he said. "It's the little things in life, which we take for granted, like hugging your kids, clapping when you go out to see your kid perform. Or touching and feeling your baby, and being able to do things which we take for granted."

While they wait for that touch to return, the Kepners count their blessings and all that has come to them since he survived his ordeal. Through the illness they got to know their neighbors and were taken into their church, Burns Memorial United Methodist.

"They're a godsend to me," Mr. Kepner said.

And looking back at everything that has happened since Mr. Kepner got sick, since his hands and feet were taken, gives them a better perspective.

"God blessed us with leaving him here," Mrs. Kepner said. "Jordan wouldn't have known her father. We would not have had our life. And he has blessed us in so many ways because of this."

Reach Tom Corwin at (706) 823-3213 or tom.corwin@augustachronicle.com.