A legacy that lives on through this foundation
The underlying cause of Kia Kermani’s sudden and preventable death is the reason why KIA KERMANI FOUNDATION has been established. Kia’s unexpected death exemplifies one of the most drastic results of medical error and negligence committed in a renowned and reputable medical center in Los Angeles.
Kia Kermani, a Caucasian male of 33 years of age, and our only child, was healthy, physically fit, athletic, studious, creative, diligent, a, sociable, and an intelligent, successful problem solver and humanist. He was dedicated and devoted to his fields of study and research, with the sole intention of benefiting others. He loved life and everyone in it, and he was loved by everyone around him. Kia was happy and leading a productive life. Kia had a vision and passion about PRECISION MEDICINE, and at work was engaged in the development and advancement of a special unit of single cell liquid biopsy technology, which is currently used in advanced medical centers.
WHY, WHEN, WHERE AND HOW DID HE DIE?
In November 2018, when Kia returned from a trip to China, he expressed persistent respiratory tract disturbances leading to his heart involvement with ejection fraction of 20 to 25. The attending cardiologist refused to test him for viral respiratory panel, instead putting Kia on Lasix ( a diuretic ) medication. (Error #1: Failure to test)
On the evening of December 25, 2018, Kia was transported to the emergency room and then hospitalized in Los Angeles. In the hospital, Kia was visited and examined by various physicians, including a cardiologist, an electro cardiologist, a heart transplant specialist, several neurologists, a psychiatrist, an infectious disease specialist, an endocrinologist, a gastroenterologist, a nephrologist, and a special nurse practitioner. Kia’s metabolic, kidney, and liver function tests were within expected normal range, however, his heart ejection fraction had dropped to 15 -20 and continued with his respiratory distress and gastrointestinal disturbances.
As an anxious father and having an extensive background in Immunology and more than 45 years of experience in the medical diagnostic field, I asked the infectious disease specialist and insisted that he order a panel of respiratory viral profiles. He first expressed that it was not necessary, but was finally convinced to order the viral panel. After a few days the results showed that Kia was infected with nonvirulent Corona virus 229E. The doctor did not take the findings seriously and Kia was never treated for Corona 229E, even while he was exhibiting high levels of the viral particles towards the end of his life. (Error #2: Failure to address the virus)
It is well known that this strain of Corona, which is considered a non- virulent strain, can potentially cause problems because its pathogenicity is based on an infectious agent extension of virulence, as well as the host’s physical condition. As a matter of fact, Corona virus 229 E has shown to cause a mild upper respiratory infection in certain individuals, and causes severe pneumonia, myocarditis, and gastrointestinal and liver inflammation in others.
The hospital’s heart transplantation team concluded and determined that Kia was a candidate for heart transplantation. After their assurance that they had found a perfect match based on alleged compatibility and immunological testing, Kia underwent a heart transplantation on January 16, 2019.
Initially, the surgical procedure was successful. Two days after the heart transplantation, Kia appeared to be in good physical condition and a sound state of mind, with a heart ejection fraction of seventy (70), and normal blood pressure. However, on the third day post-transplantation, Kia exhibited increased heart beat with decreased blood pressure, which seriously concerned me. I immediately called the transplantation team and raised the question about the possibility of Kia having an adverse immunological response to the donor’s allotype (HLA and non-HLA). The team assured me that his symptoms were normal after surgery and that the team of doctors were “carefully monitoring him”. In addition they told me that their immune evaluation showed Kia had negative immune activity against the donor. On January 22, 2019, the transplantation team performed a heart biopsy on Kia and we were informed that “Kia’s donated heart showed no sign of immune graft rejection” The doctor had scheduled to release Kia from the hospital on January 24, 2019. (Error # 3: Failure to perform adequate Histocompatibility testing, as well as reliable immunological assessment before and after the transplantation surgery)
Unexpectedly on January 24, 2019, Kia underwent a massive heart failure and was taken to surgery and placed on ECMO. After he returned from surgery, his blood sample was taken for immune evaluation by an immunoassay technique. The test order was sent to an outside lab without requesting STAT results. This would have minimized the time for the results to become available. As matter of fact this test should be ordered on third day after surgery, when Kia became symptomatic and treated Kia properly to prevent his heart failure (Error # 4: Failure to delay testing and order STAT for immunological assessment)
In contrast to the biopsy test result that was reported negative, the immunoassay test results showed Kia carried high circulatory donor specific non- HLA IgM, IgG anti endothelial cell antibodies, anti PRKCH antibodies, and weak non-HLA donor specific anti MICA (MIC 28) antibodies respectively. This explains the cause for his immune mediated heart graft rejection and heart failure. If the heart transplantation team had not ignored my recommendation to perform the immunological test earlier, and if they had ordered the test as STAT, the crucial time needed for proper treatment would not have been lost and the ultimate outcome would have been very different.
Kia was treated with Eculizumab (anti C5 complement antibody), immunoglobulin and plasmapheresis and went through five surgeries and numerous invasive procedures. He was highly intubated and received numerous blood transfusions without being checked for bleeding ulcers during the remainder of the month of January and through all of February 2019. (Error # 5: Failure to test and find the cause of bleeding ulcer)
During the second week of February, Kia exhibited some improvement in his ejection fraction but shortly after, demonstrated elevated heartbeat and low blood pressure again with kidney failure, including leukocytosis and respiratory distress. He was neither reassessed for immune reactivation, nor was he monitored for the donor specific non-HLA antibodies. When I approached the key physicians on the transplant team and asked about the necessity of doing an immune assessment and evaluation, including the donor specific non- HLA antibodies and appropriate treatment, they thought it was a good idea and promised that it would be done. It was never carried out. (Error # 6: Further failure to perform adequate testing)
The team of doctors were optimistic and scheduled Kia to walk on February 27, 2019. However, on February 27, 2019 at 6:45 AM, to everyone’s surprise Kia’s life succumbed to complications resulting from AMR, heart failure, drug incompatibility and toxicity, and Corona 229E respiratory failure. This could have been prevented if proper, early, and specific diagnosis, were made, followed by proper monitoring and appropriate treatment. We are confident that with proper and timely testing through the treatment process, the outcome would have been quite different and could have prevented much of Kia’s needless pain and suffering.
MEDICAL NEGLIGENCE THAT CAUSED KIA’S DEATH:
Incomplete Organ Matching: It is evident that there was incomplete organ matching between the donor and Kia due to (i) low sensitive histocompatibility testing that was performed, (ii) lack of testing for key non-HLA polymorphic variants disparity between donor and recipient (Kia), such as endothelial, PRKCH, MICA, KIR, and (iii) gender and sex mismatch.
Failure to Perform Pharmacogenetics Studies: No Pharmacogenetic testing was performed for immune suppressive agents such as use of tacrolimus, prior to the administration. It must be noted that pharmacogenetics studies are critically essential in organ transplantation for both donor and recipients. In Kia’s case, no pharmacogenetics studies were performed and therefore he developed various reactions to the administered drugs, causing numerous organ malfunctions. Such organ malfunctioning included nephrotic failure, hepatic dysfunction, pancreatic, circulatory malfunctioning/ hyperglycemia, and GI disturbances.
Inadequate and Outdated Medical Protocols and Standards: Immune evaluation and immune monitoring’s protocol that was initially followed and applied to Kia’s case was based on testing panel reactive antibody (PRA) / donor specific antibody (DSA) by Luminex technology and later by heart biopsy respectively. The testing based on hospital protocols exhibited negative results, while the outsourced immunoassay test that I had insisted demonstrated that Kia’s blood was highly positive for circulatory antibody mediated rejection (AMR). Kia was carrying high level of donor specific circulatory IgM, IgG anti donor polymorphic endothelial cell antibodies, anti PRKCH antibodies and low levels of anti – MICA (MIC28) antibodies, played as antibody mediated rejection (AMR). AMR exerted a critical role in Kia’s heart rejection and failure, as well as his circulatory system, which lead to erroneous steps taken by the transplantation team. The transplantation team, with the timely knowledge of the aforementioned facts, could have treated Kia with Rituximab (anti CD20 B cell antibody) to block the reactivation of memory B cell. Instead they followed the hospital’s inadequate protocols and standards and waited until a second heart failure occurred, which caused Kia’s sudden and untimely death.
Failure to Properly Evaluate the Cause of Kia’s Anemia: The cause of Kia’s anemia was not properly evaluated while he underwent numerous surgeries and invasive procedures for diagnostic purposes and treatments, though he received frequent blood transfusions. Sadly, Kia’s gastric bleeding was not treated until we specifically requested this treatment. It is worth noting that frequent blood transfusion is potentially a source of infectious disease, as well as for the development of alloantigen, alloantibodies, cytokines, or exosome in blood, which likely plays a critical role in further immune activation, tissue injury, etc.
Failure to address the Corona Virus Infection: Surprisingly, Kia’s Corona Virus 229E infection that persisted at a high viral load through his end stage, was completely undetermined. We are fully convinced and strongly believe that if proper Precision Medicine standards, which were a part of Kia’s broader vision for healthcare, were applied in his own case, he would still be alive today to serve others. This is the reason we are so committed and determined to establish and grow the “Kia Kermani Foundation.” The Kia Kermani Foundation strives to pursue Kia’s dream and honor his legacy by providing resources for the development and advancement of Precision Medicine in the hopes that the development of this practice will save many other precious lives such as that of our beloved Kia.