Earlier this year, three ACS Fellows led a milestone quadruple organ transplant for a patient with advanced cystic fibrosis (CF), restoring critical organ function and improving quality of life. The successful case is now being reported.
A recent case report from UChicago Medicine highlights this January procedure—one of the rarest in modern organ transplantation—which involved simultaneous bilateral lung, liver, and kidney transplantation in a 28-year-old woman with advanced CF.
The three Fellows leading the operation were thoracic surgeon Pablo Sanchez, MD, PhD, FACS, the Lowell T. Coggeshall Professor of Surgery and surgical director of the Lung Transplant Program; Rolf N. Barth, MD, FACS, chief of the Section of Transplant Surgery and director of liver, kidney, and pancreas transplantation; and Ashley Suah, MD, FACS, assistant professor of surgery, all at UChicago Medicine.
The operation is believed to be the first of its kind in Illinois and only the sixth reported in the US.
The patient had progressive multisystem complications of CF, including chronic pulmonary infection, CF-related liver disease, renal failure, and CF-related diabetes. Her deteriorating condition highlights the ongoing burden of extrapulmonary organ failure in adults with CF, even in the era of CFTR modulators. Importantly, she was unable to tolerate modulator therapy, highlighting that transplantation remains a critical salvage strategy for select patients.
Surgeons elected to transplant the lungs in addition to the liver and kidney because the patient’s native lungs harbored multidrug-resistant bacteria that posed a substantial risk of postoperative seeding of the donor organs once immunosuppression was initiated. In that way, the procedure served not only as organ replacement but also as definitive source control.
The operation required staged coordination across thoracic, abdominal transplant, and critical care teams over approximately 36 hours. Bilateral lung transplantation was performed first, including intraoperative antibiotic lavage of the chest cavity before implantation. The liver transplant followed using normothermic machine perfusion technology to preserve graft viability during the prolonged operative sequence.
Because of physiologic stress and hemodynamic considerations, the kidney transplant was delayed until the following day, after the patient was stabilized in the ICU.
The case also reinforces broader lessons from high-volume multi-organ transplant centers: outcomes depend heavily on institutional coordination, donor matching logistics, and integrated perioperative management. The success of the Fellows and the transplant care team makes it clear that successful multi-organ procedures require not only technical expertise but also sophisticated immunologic and operational planning.
