Surgeons at Northwestern Memorial Hospital successfully transplanted a second set of lungs, a liver, and a kidney into a patient with cystic fibrosis and chronic organ rejection.
RT’s Three Key Takeaways:
- Complex Lung Retransplantation: Surgeons successfully performed a second double-lung transplant alongside liver and kidney transplants for a patient with restrictive allograft syndrome.
- Machine Perfusion Technology: The use of advanced machine perfusion allowed the surgical team to preserve the liver and kidney outside the body, providing the time necessary to complete the lung retransplantation.
- Multidisciplinary Coordination: The eight-hour procedure required simultaneous collaboration between thoracic and abdominal transplant teams to manage high risks of bleeding and organ rejection.
Surgeons at Northwestern Medicine have performed the first known quadruple-organ transplant involving retransplanted lungs in the US, according to the organization. The patient, 36-year-old Elizabeth Wehrle, received a second double-lung transplant, a liver, and a kidney after complications from cystic fibrosis and chronic rejection of her first lung transplant.
The procedure, which took place at Northwestern Memorial Hospital, involved a multidisciplinary transplant team managing a patient who had developed a rare and often fatal form of rejection known as restrictive allograft syndrome (RAS).
“Retransplanting lungs is extraordinarily difficult because prior surgery can leave the chest densely scarred and the normal anatomy severely distorted,” said Ankit Bharat, MD, chief of thoracic surgery and executive director of the Northwestern Medicine Canning Thoracic Institute, in a news release. Bharat added that the initial 2017 transplant left extensive scar tissue, which increased the risk of bleeding, injury to nearby vessels, and organ rejection.
Wehrle was referred to Northwestern Medicine with progressive respiratory failure, requiring a ventilator and extracorporeal membrane oxygenation (ECMO). During evaluation, physicians found that cystic fibrosis complications had also caused liver and kidney failure.
To manage the complexity of the eight-hour procedure, the team utilized advanced machine perfusion technology to preserve the donor liver and kidney outside the body. This approach allowed the thoracic surgeons to complete the lung retransplant before the abdominal surgeons began their portion of the operation.
“The liver and kidney were on a machine perfusion pump, which was fantastic because it allowed the lung team to take their time and make sure the lungs went in safely without being on the clock for the abdominal organs,” said Satish Nadig, MD, PhD, transplant surgeon and director of the “Northwestern Medicine Comprehensive Transplant Center,” in a news release.
The operation required precise coordination between the thoracic and abdominal transplant teams, as well as anesthesia, intensive care, and nursing staff.
“The whole operation had to be very closely coordinated, with so many team members and two different teams working in extremely close collaboration to make sure there was no single misstep,” said Chitaru Kurihara, MD, a thoracic surgeon and surgical director of the lung transplant program at the Canning Thoracic Institute.
Wehrle recovered following the March procedure and was discharged from the hospital in less than three weeks. She is currently walking 3 to 4 miles per day as she continues her recovery, according to Northwestern Medicine.
