DukeMed Alumni News
Fall 2007

Never Letting Go:
Markert says pediatric care extends beyond discharge

By Bernadette Gillis

Early in her career as a pediatrician at Duke, M. Louise Markert, PhD’81, MD’82, HS’82-’84, says she believed all of her training and research had rendered her an expert when it came to treating certain childhood diseases.

But to her surprise it was a child’s parent who forever changed her approach to patient care.

Markert recalls visiting with the child’s parents every day and telling them their child was sick and might die.

“Finally one day the mother said to me ‘Louise, you should play with my baby. Show me that you care for my baby, and then you can talk to me about this.’”

Today Markert primarily treats children with a fatal genetic disorder called complete DiGeorge Syndrome, and not only does she play with them while in the hospital, her relationships with the children and their parents last long after the children are discharged.

She stays in touch with each family through phone calls, letters, and e-mail. She even makes an effort to visit and take part in special events such as kindergarten graduations and awards ceremonies, no matter the distance.

“I never let go,” she says. “I tell them they’re stuck with me for life, and we’re holding hands wherever they are in the United States or somewhere else.”

Children born with complete DiGeorge syndrome have no thymus, a gland important in the development of T cells. The thymus teaches T cells to fight infection while not attacking the body’s own tissues. Without treatment the children usually die from infection.

Building upon programs that had already been established at Duke by Rebecca H. Buckley, MD, WC’54, HS’58-’64, in immunodeficiency
diseases and Barton Haynes, MD, HS’73-’75, on human thymus tissue, Markert found a novel way to prepare thymus tissue—normally discarded during pediatric heart surgery—for transplantation.

The pediatric general surgery team at Duke then transplants the tissue into children with DiGeorge syndrome.

Of the 48 children who have received the transplant since 1993, including three this year, 33 are alive and doing well. The first patient who successfully received the transplant is now in the eighth grade.

Because Duke currently is the only medical center where thymus transplantation is performed, children come from all over the world seeking treatment.

“Some have never traveled before,” she says. “You can envision how scared they are.”

So Markert does her best to make the families feel comfortable.

While Markert and her team dress in masks, gowns, and gloves when entering the child’s room, the parents do not.

“I think development is so important in the first year, and how can you develop if you can’t touch your parents or if you can’t see their faces? There is some risk in allowing that to happen, but I really want the parents to be able to love their children and touch their children.”

Even though the thymus transplantation has proven successful for many DiGeorge patients, the procedure is still experimental. But Markert and her team continue their research (funded by the National Institutes of Health and the U.S. Food and Drug Administration) in the hopes that the transplant will be funded more easily by Medicaid and insurance companies. It currently takes a long time to obtain approvals.

Markert and her team are collaborating with Great Ormond Street Hospital in London to teach the procedure to doctors there.

In addition to treating DiGeorge, one of their goals is to find new treatments
for other autoimmune diseases such as lupus.

On the home front, Markert says numerous people all across Duke have done their part to help save these children’s lives—from the staff in the microbiology lab to the families of the children who have donated their thymus glands. “They all do it happily for a child they’ll never see,” she says.