Last Christmas will no doubt remain seared in Sheila Williams' memory. Days earlier, her 5-month-old daughter was rushed to University of Maryland Medical Center with seizures and soaring blood pressure. The girl's kidneys had shut down, and she clung precariously to life.
"I was scared - terrified," Williams said yesterday. "She was just a little baby, and she was going through all this. I didn't think babies even got kidney failure."
This year, the holidays should have a much rosier cast. Two weeks ago, Williams donated her left kidney to her daughter, Kahla Tallie, capping what has been a difficult year of dialysis, injections and uncertainty.
Kahla became the youngest patient to receive a kidney at the Baltimore hospital, which has performed more than 400 such operations this year and is the nation's busiest kidney transplant center.
It's a record that perhaps has more significance for the hospital than for Williams, who is just glad to see her daughter looking chubby and bright - and ready for a homecoming tomorrow.
"It's a very nice Christmas present to bring her home this year," said Williams, 23, a former nursing home dietary aide who lives in Northeast Baltimore.
Doctors are not sure what led to the baby's problems. They know she was taken to the hospital in the throes of hemolytic-uremic syndrome, a disease that is usually caused by a dangerous strain of E. coli bacteria.
Victims often acquire the infection by eating undercooked hamburger meat or other tainted foods. But Kahla wasn't yet eating solid foods, so the source remains a mystery.
"Most kids who get hemolytic-uremic syndrome get better," said Dr. Susan Mendley, a pediatric kidney specialist who took care of Kahla. "They don't require dialysis, but Kahla did. She was very ill."
Doctors inserted a tube into the girl's abdomen, and nurses trained her mother in a type of dialysis that can be done at home.
The treatment saved Kahla's life, but doctors never considered it a long-term solution.
"It was always expected that when she became large and stable enough, she would get a kidney transplant," Mendley said. Doctors considered 22 pounds to be about the right size.
Doctors also believed Kahla would respond best if she received a kidney from a living donor. Such organs respond faster and more reliably than kidneys taken from a cadaver. There is less chance of patients having to resort to hemodialysis - a burdensome procedure that is done with intravenous tubes - in the event of failure.
Relatives were screened, and the girl's mother was judged to be the most suitable donor. She never flinched.
"When I found out I was the best match for a kidney, I went ahead and did it," Williams said. "I would do anything to make my daughter's life better."
In August, surgeons removed Kahla's nonfunctioning kidneys because they were the source of her hypertension. On Dec. 6, mother and daughter were placed in adjacent operating rooms, and the transfer was made.
Dr. Alan Farney, who has performed more than 70 kidney transplants this year, inserted the new kidney through an incision in the girl's abdomen.
One challenge was that the adult organ, several times larger than a baby's normal kidney, consumed about half of the child's blood supply. To maintain normal blood flow, anesthesiologist Monique Bellefleur supplied a blood transfusion and monitored Kahla's blood pressure.
For the surgeon, working on a patient so young had disadvantages and advantages. Kahla's blood vessels were extremely narrow, but they were also more pliable than the vessels of adults who have had hard plaques accumulating for years.
To Farney's delight, the new kidney turned from gray to a healthy pink almost immediately and began producing urine within minutes.
Since the operation, Kahla has done well despite one bout of fever, according to her doctors.
"I get a lot of satisfaction helping our adult patients, but when it comes to a child I'm euphoric," Farney said. He said a highlight of his day comes when he visits Kahla on rounds.
Doctors say the main risk Kahla faces is rejection, the immune system's tendency to attack foreign organs. Kahla will require about a dozen medicines a day during the coming year and will take lesser regimens for the rest of her life.
"We think she's going to grow up a normal kid, although it is possible that when she becomes a teen-ager or young adult she will need another transplant," Mendley said. "We expect she'll have normal growth and development."
Kahla has spent the past two weeks in the hospital. Williams was discharged three days after surgery. She has spent most of her waking hours visiting Kahla.
She said she looks forward to spending a quiet Christmas at home, where she lives with her fiance, Jeffrey Tallie, and their children, Jeffrey, 4, and Kahla.
This year, she said, the spirit of giving has taken on a new dimension.
"My mother said I have given Kahla the most wonderful gift I could have ever given," Williams said.
