ACS Fellows Perform US-First Quadruple Organ Transplant Involving Retransplanted Lungs

Surgeons at Northwestern Memorial Hospital in Chicago, Illinois, have performed what is believed to be the first quadruple-organ transplant in the US involving retransplanted lungs, marking a significant milestone in complex multiorgan transplantation. 

The procedure was led by Ankit Bharat, MD, FACS, chief of thoracic surgery and executive director of the Northwestern Medicine Canning Thoracic Institute and Satish N. Nadig, MD, PhD, FACS, transplant surgeon and director of the Northwestern Medicine Comprehensive Transplant Center. 

They operated and oversaw a team that treated a 36-year-old female patient with cystic fibrosis whose previous bilateral lung transplant had been complicated by chronic rejection, progressive liver disease, and kidney failure. She underwent retransplantation of both lungs along with transplantation of a liver and kidney during a coordinated operation involving multiple surgical teams. 

The patient initially received a double-lung transplant in 2008, which allowed her to live an active life for more than a decade. However, chronic lung allograft dysfunction eventually led to respiratory failure. Her worsening pulmonary disease was compounded by advanced liver dysfunction and renal failure, leaving transplantation of a single organ insufficient. 

Because failure of any one organ threatened the success of the others, surgeons determined that simultaneous replacement of all four organs offered the best chance for survival. 

After a compatible donor was identified, thoracic transplant surgeons first performed the bilateral lung retransplant overnight. Once the patient was stabilized, abdominal transplant teams proceeded with the liver and kidney transplants the following morning. The case demanded careful logistical planning, synchronized operating room resources, and seamless collaboration among thoracic surgery, abdominal transplant, anesthesia, critical care, perfusion, nursing, and transplant coordination teams. 

Only a handful of quadruple-organ transplants have ever been performed in the US—including one earlier this year, also led by ACS Fellows—making this case particularly notable because it also involved retransplantation of both lungs, which presents unique technical and immunologic challenges due to prior operative adhesions, altered anatomy, and heightened risks of rejection and perioperative complications. 

Following recovery and rehabilitation, the patient was discharged with functioning grafts and was expected to return home to Iowa. 

As transplant programs continue to refine approaches to complex retransplantation, cases such as this may inform future strategies for managing patients with multisystem organ failure who previously had few therapeutic options.