Opinion ID: 220774
Heading Depth: 3
Heading Rank: 1

Heading: Huerta’s Kidney Transplant and Rejection

Text: In August of 2003, Huerta, seven years old at the time, received a kidney transplant. As part of her medication regime, she took immunosuppressants, including tacrolimus and Cellcept, to help prevent her body from rejecting the transplanted kidney. In February of 2006, Huerta was hospitalized after she suffered a series of pneumonias 1 Tacrolimus is an immunosuppressant that was prescribed to Blanca to prevent her body from rejecting the kidney transplant. A body’s immune system normally attacks foreign tissues, including transplants, resulting in the body’s rejecting the organ transplant. Paul S. Russell, M.D., Transplantation, in THE MERCK MANUAL OF MEDICAL INFORMATION 1076 (2d ed. 2003). Immunosuppressants can usually control rejections by suppressing the immune system and therefore the body’s ability to recognize and destroy foreign substances, such as transplant tissue. Id. Potency refers to the amount of a drug needed to produce an effect. G. Victor Rossi, PhD, Drug Dynamics, in THE MERCK MANUAL, supra, at 73. “Subpotent tacrolimus” thus refers to a preparation of tacrolimus that contained less than the prescribed amount of tacrolimus. 2 The parties consented to Magistrate Judge Robert Hayes Scott’s serving as the presiding judge and entering final judgment in this action pursuant to Title 28, United States Code, Section 636(c) and Federal Rule of Civil Procedure 73(b). Accordingly, the references in this order to the “district court” refer to Magistrate Judge Scott. -2- that did not clear with antibiotics. On March 8, 2006, Huerta’s treating nephrologists replaced Cellcept with a weaker immunosuppressant, Imuran, because they believed that Cellcept over-suppressed her immune system and may have increased her risk of infection. Huerta continued to take tacrolimus. On May 15, 2006, Huerta was admitted to the University of New Mexico Hospital (UNMH) after she had been vomiting for three nights. Physicians at UNMH determined that Huerta was suffering an acute, severe, and sudden rejection of her kidney transplant. Dr. John Brandt, one of Huerta’s treating nephrologists, reduced Huerta’s tacrolimus dosage on May 15 because he was concerned that she might have too much tacrolimus in her system. Huerta’s tacrolimus level on May 15th was not measured and the experts appear to agree that without a measurement, there is no way to know what Huerta’s tacrolimus level was on that day. On May 17, 2006, lab reports showed that Huerta’s tacrolimus level was 2.5. Before Huerta’s kidney rejection, her last tacrolimus level was measured at 5.4 on April 12, which is apparently considered normal. Huerta partially recovered from the May 2006 rejection episode but suffered another rejection episode in May 2007. The treatment notes from Huerta’s May 2007 rejection episode showed that “she had undetectable levels” of tacrolimus and her doctors were concerned “that her mother wasn’t dosing her properly.” Mem. Order and Op. Granting BioScrip’s Motion to Exclude Proposed Testimony of Doctors Craig Wong, Bruce Morgenstern, and Loyd Alexander, August 13, 2010 (“Aug. 13, 2010 Op.”) at 8 & nn. 6 & 7. Only Huerta’s 2006 rejection is at issue in this case. -3- Just prior to Huerta’s 2006 kidney rejection, a distributor of tacrolimus issued a recall for its tacrolimus which was found to be subpotent. It is undisputed that the BioScrip tacrolimus was not subject to the recall.