Chicago-based Northwestern Medicine has performed the first known quadruple-organ transplant involving retransplanted lungs in the U.S., the health system said in a July 14 news release.
The recipient, 36-year-old Elizabeth Wehrle of Montezuma, Iowa, needed a rare four-organ transplant for new lungs, a liver and kidney after her body rejected the lungs she received in 2017 and cystic fibrosis damaged her other organs.
Six things to know:
1. Ms. Wehrle is the first patient in the U.S. to receive a quadruple-organ transplant involving retransplanted lungs, according to the Scientific Registry of Transplant Recipients. Northwestern is the sixth U.S. program to perform a quadruple-organ transplant of any kind — and the first to do one with retransplanted lungs. Only seven such quadruple-organ procedures have been performed nationally to date.
2. Ms. Wehrle’s 2017 double-lung transplant, performed at another health system, left dense scar tissue that “severely distorted the normal anatomy of her chest,” according to a Northwestern news release.
“When you make an incision, the risk of bleeding and injury to nearby organs and blood vessels increases, and with four organs involved, there’s an even greater risk of organ rejection and serious infection,” Ankit Bharat, MD, chief of thoracic surgery and executive director of Northwestern Medicine’s Canning Thoracic Institute, said in the release.
3. After getting sick in January, Ms. Wehrle was diagnosed in late February with restrictive allograft syndrome, a form of chronic rejection that Dr. Bharat said is “often fatal and so high-risk that many transplant centers wouldn’t consider repeat lung transplantation.”
Cystic fibrosis complications had also damaged her liver and kidney. By the time she was referred to Northwestern, she was in progressive respiratory failure on a ventilator and extracorporeal membrane oxygenation.
4. Rather than attempt a single procedure, thoracic surgeons handled the lung retransplant first, on the evening of March 22; the abdominal team took over hours later for the liver and kidney. Surgical implantation took about eight hours.
“If one surgeon had tried to do this as a single 20-hour operation, that would have been too much stress on a critically ill patient,” said Chitaru Kurihara, MD, surgical director of the Canning Thoracic Institute’s lung transplant program.
5. To buy surgeons more time, Northwestern used machine perfusion to keep the donor organs functioning outside the body, extending the window beyond what cold storage allows. That let the thoracic team work without racing the clock on the abdominal organs.
6. Ms. Wehrle was discharged in less than three weeks and has resumed light weightlifting and daily walks of three to four miles, the release said. She returns to Iowa on July 17 to reunite with her 11-year-old son.
Northwestern’s lung transplant program, launched in 2014, has performed more than 700 lung transplants and reports a median wait time of three days — among the shortest in the U.S., according to the health system.
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