Adopted toddler from India flourishes after liver transplant

EAU CLAIRE — At just 2½ years old, Ary Krejchi already has come a long way.

Ary was born in India, where he spent the first 20 months of his life in an orphanage before being adopted by Serena and Jon Krejchi of Eau Claire.

The boy also was born with biliary atresia, a rare liver disease that left him so malnourished he weighed only 11 pounds, had broken bones all over his frail body and had to be held like a baby when the Krejchis welcomed him into their lives.

One year later, after undergoing a liver transplant in September at Mayo Clinic in Rochester, Minnesota, Ary’s transformation is stunning. His weight has more than doubled, his smile is nearly constant and he struts around the family’s living room — still with a helping hand from mom or dad — like he owns the place.

“His personality has really developed since the transplant. He’s a completely different child,” Serena said. “It feels like we’ve had him forever now.”

Mayo liver specialist Dr. Sara Hassan said it has been heartwarming to see Ary’s progress.

“What a joy it is now to see him hold Elmo and to smile and blow kisses and steal the hearts of all the nurses on the floor,” said Hassan, a pediatric gastroenterologist and pediatric transplant hepatologist.

“He had all the odds stacked against him and he just pushed through. It’s really a miracle.”

But it was a long, difficult journey for Ary and his adoptive parents between western India and their home on the northeast side of Eau Claire.

It all started when the Krejchis determined they wanted to start a family.

“We knew we wanted children, but our family was not growing as we anticipated,” Serena said.

That realization prompted them to begin the adoption process about four years ago.

As they looked into international adoption, the young couple felt drawn to India because Jon’s sister-in-law is from that country and they felt having family to help them learn about the culture would be extremely valuable. Jon and Serena were not dissuaded after being told that all international adoptions from India, a nation with more than 30 million orphans, involve special needs children.

“We just wanted to be open as much as possible,” Serena said.

Jon quickly added, “There are too many kids without families.”

As they scoured the profiles of Indian orphans, the Krejchis kept coming back to Ary. They learned nothing about his biological parents but had access to enough medical information from their international adoption agency, Birmingham, Alabama-based Lifeline Children’s Services, to know he was malnourished and likely would need a liver transplant.

“We felt like we could love Ary,” Serena said. “Jon and I both have some medical knowledge, so we felt like we could help him with his medical needs.”

Jon is an emergency medical technician with the Chippewa Falls Fire Department, and Serena is deputy medical examiner for Eau Claire County and a dispatcher for Chippewa County.

Overcoming hurdles

After committing to adopting Ary, Serena and Jon booked flights to India and back last April. They left April 12 and were scheduled to take custody of Ary four days later from his orphanage in Aurangabad, a city of more than a million people. The big moment was delayed by three days because of concerns about COVID-19.

After clutching Ary in their arms, the couple flew to New Delhi, where they had more paperwork to complete before returning to the U.S. The process derailed when, during a routine COVID screening, Ary registered a slightly above normal temperature of 99.4 degrees.

The Krejchis were told they couldn’t go to their appointment without getting a COVID-19 test at a hospital. The unwelcome development got worse when they arrived at a local hospital to find about 30 people outside waiting in line to get into the emergency department.

“It was 103 degrees outside and Ary was in liver failure,” Jon said as Ary pushed a little blue police car across the floor. “He was so sick and so weak that he couldn’t even hold his head up at that point.”

Hanging over their heads amid the setbacks were persistent rumors that all international flights were about to be canceled in an effort to stop the spread of COVID-19, which was surging at the time in India. If they couldn’t get back to the U.S. soon, they feared Ary might not make it.

At one point, they met a Christian missionary with a history of helping adoptive families who volunteered to drive the couple to a government office in hopes of acquiring an exit permit.

“It was a 45-minute ride with a guy we met the night before in a hotel lobby,” said Jon, who shares the same birthday as Ary. “He was an angel. I really think he saved Ary’s life because he got the paperwork we needed done for us.”

It took two days to get their exit permit, with the Krejchis showing officials documents from University of Minnesota doctors who had reviewed Ary’s medical records stating that he was likely to need a liver transplant. They received the permit the day before their scheduled flight back to America.

Less than 24 hours before the flight was scheduled to depart, they got an email saying it was canceled, launching them into a frenzy of searching for alternative flights out of India, almost all of which were completely booked.

After buying tickets for a 2 a.m. flight to Germany, the family got in line for yet another COVID test to be certain they would satisfy any international requirements. When the line barely moved in two hours, other people noticed how sick Ary was and insisted the Krejchis go to the front of the line. The kindness was a huge relief, especially after enduring disapproving looks at other points in the trip from residents who likely presumed they were tourists possibly spreading the virus.

Just when the family thought everything was in order, they went to check their bags and were informed that Ary would not be allowed to board because Indians need a visa to land in Germany. The ruling came despite the reality that Ary, as the adopted son of American parents, would get U.S. citizenship as soon as he landed in the United States.

They spent at least 12 hours in the New Delhi airport frantically seeking solutions before Serena’s father and brother in Eau Claire found them a series of flights that took them to Paris, Chicago and, finally, Eau Claire. After being awake for more than 24 hours — in part because Ary cried through much of the trip — they reached their Eau Claire home at about 11 p.m. on Sunday, April 25. Serena and her father drove away at 3:30 a.m. the next day to make Ary’s appointment at Mayo. Jon followed a few hours later.

Immediately recognizing how sick Ary was, Mayo doctors admitted him to the hospital and discovered fractures all over his body, including on his spine, ribs, femur and forearm. Jon recalled that a surgeon told him that Ary’s bones felt like a Tootsie Roll. Ary’s initial laboratory results showed almost nothing within normal limits.

“I’ve seen a lot of sick kids, but I was scared for him,” acknowledged Hassan, the liver specialist.

First, Ary’s care team tried to improve his nutrition and put about 60% of his tiny body in a bright red cast to allow his broken bones to heal.

Still, Jon said, doctors made it clear that Ary’s hold on life was precarious.

Hassan, who the Krejchis call Ary’s other angel, remained positive even though Ary was nearly two years behind the preferred surgery timetable for U.S. infants with the same liver disease, which blocks bile from moving from the liver to the small intestine. He also was so dehydrated and sick that the major blood vessels to his liver were clotted, adding to the risk of surgery.

“One of the biggest things we needed to estimate was if he could survive the stress of an operation if we put a new liver in him,” Hassan said.

Hassan discussed the options and risks with the family.

“We just wanted to give him every chance that we could to be healthy,” Serena said.

With that vote of confidence, Hassan said the response from Mayo surgeons was, “OK, let’s take it on. Let’s try.”

After three months of treatment, Ary was stable enough that his name was placed on the national transplant list in July.

Fortunately for Ary, due to the severity of his condition, he rose to the top of the list and a matching child’s liver became available two months later.

Jon, Serena and Ary were in the car heading for Rochester within an hour of getting the call.

Ary underwent liver transplant surgery on Sept. 16, 2021, at Mayo, becoming one of just 186 liver recipients nationwide last year between the ages of 1 and 5, according to the United Network for Organ Sharing.

“Of course he was a champ,” Hassan said. “He just did fantastic.”

‘Gift of life’

While the Krejchis weren’t told any information about the donor, they are grateful beyond words for that generous gift at a time of tragedy for another family.

Following privacy protocols, the Krejchis reached out to the donor family with a letter, and it’s up to them if they eventually want to contact the Krejchis, who are hopeful they get a chance someday to say “thank you” in person.

Both Serena and Jon said they either are or plan to be registered as organ donors.

“You never know who you’re going to help and what their story might be,” Serena said. “It literally means the world to someone and to their entire family.”

Hassan is a huge advocate for organ donation — something celebrated every April during National Donate Life Month — because she regularly sees the joy families experience after receiving what she called the “gift of life.”

“We really appreciate everyone who is so selfless where even in their own time of grief they decide to save another person’s life,” Hassan said. “In my eyes, it’s really the most altruistic act you can do. It restores my faith in humanity.”

No restrictions

Seven months removed from his transplant, Ary is still not on the growth chart for weight, Serena said, adding, “But he’s super close.”

Yet proper liver function has helped him blossom into an energetic toddler who pulls himself up using a couch, loves to ride his tricycle outside and outlasts anyone willing to exchange repeated whispers of “Hi.”

Already, Serena and Jon said, they can’t imagine their lives without Ary, whose tears after bumping himself on the couch vanish almost immediately after Serena blows bubbles that dance in front of his wide eyes that already have seen so much.

“He brings so much happiness to us and to others,” Serena said, smiling broadly at the newest member of their household.

While he will have to be on anti-rejection medication for the rest of his life, Ary otherwise has no restrictions.

“He can be active, play sports and do everything a normal child can do,” Serena said.

Likewise, Ary’s doctor offers an optimistic prognosis.

“I think he’s going to fly,” Hassan said. “I think he’s going to do great.”

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