Taking lessons learned during COVID-19 pandemic, new program will perform more double lung transplants for terminal patients

After successful surgeries, Northwestern unveiled plans to provide more double lung transplants for patients with terminal lung cancer. Previously, when treatments such as chemotherapy and radiation failed, there were no more treatment options. That is changing thanks to lessons learned during the COVID-19 pandemic.

Lisa Schencker | (TNS) Chicago Tribune

When traditional treatments such as chemotherapy and radiation fail, lung cancer can be a death sentence for many patients.

That, however, may be changing, with Northwestern Medicine leading the way.

Northwestern plans to begin regularly performing double lung transplants on patients with terminal lung cancer, after successfully transplanting lungs into two patients who would have otherwise died of the disease, the health system announced Wednesday.

Northwestern surgeons successfully performed a double lung transplant on Albert Khoury, then 54 of Chicago, in 2021, after he was diagnosed with stage 4 lung cancer. Northwestern then performed a second similar transplant on Tannaz Ameli, 64, of Minneapolis, last July. Moving forward, Northwestern hopes to do at least 10 to 15 such transplants a year. The outcomes of the first 75 patients to participate will be tracked in a new research registry available on ClinicalTrials.gov.

“We are really excited about this because these are patients that are some of the most hopeless patients because a lot of them are going to be at the end of the road, and to be able to make such a dramatic impact, it’s quite compelling,” said Dr. Ankit Bharat, chief of thoracic surgery and director of Northwestern Medicine Canning Thoracic Institute.

Until now, lung transplants on patients with advanced lung cancer have been rare operations. Typically, patients with cancer are not eligible to receive organ transplants because it’s feared that the cancer will recur after the transplant. Patients who receive new organs must take medication to suppress their immune systems, which can lead to a recurrence if any cancer cells are left in the body.

Northwestern doctors, however, used lessons learned during the COVID-19 pandemic to perform the transplants on cancer patients. In June 2020, Northwestern performed the first known double lung transplant in the country for a COVID-19 patient whose lungs were severely damaged by the disease. During that and subsequent similar surgeries, doctors had to be careful not to contaminate the blood stream during the transplant.

“Most COVID transplants we did had tons of bacteria in them,” Bharat said. “We felt if we could carefully remove those lungs and transplant them, we probably should be able to do the same in cancer ridden lungs.”

In the lung cancer transplant surgeries, patients are put on full heart and lung bypass, while both lungs are removed at the same time, along with the lymph nodes. Doctors wash the airways and the chest cavity to clear the cancer before putting in the new lungs, he said.

Not all patients with lung cancer are eligible for the surgery. The surgery is only for patients whose cancer has not spread beyond their lungs and who have run out of other treatment options, such as chemotherapy, radiation, immunotherapy and other surgeries.

Northwestern is now working with other health systems across the country, in hopes that other hospitals will develop similar programs, giving more patients the option of a transplant, Bharat said.

The two patients who’ve already received the transplants at Northwestern are still cancer free, Bharat said.

Khoury underwent the 7-hour-long surgery in September 2021.

The year before, Khoury, who was a nonsmoker and a cement finisher in Chicago, developed back pain, sneezing, chills, and a cough with mucus. At first, he thought he had COVID-19, but he was soon diagnosed with lung cancer.

Khoury said he was told by doctors at other health systems that he wouldn’t survive. Before the transplant at Northwestern, he was on a ventilator and had developed pneumonia and sepsis. When he got a transplant, he likely only had days left to live, said Dr. Young Chae, a medical oncologist with Lurie Cancer Center at Northwestern Medicine.

“I did not know if he would make it,” Chae said at a news conference Wednesday. “His lungs were both filled with cancer cells, and day by day, his oxygen saturation was dropping.”

Now 18 months past his transplant, Khoury has gone back to work. He calls the surgeons at Northwestern his “guardian angels.”

“The first day I went back to work, I was so happy,” Khoury said. “I was like, ‘I’m back. I did it. I made it.’”

Meanwhile, as Khoury was undergoing his life-saving transplant, Ameli was dealing with a lingering cough.

She was diagnosed with stage 4 lung cancer in January 2022. She underwent chemotherapy, without success, and was recommended for hospice. Her husband reached out to the Northwestern Medicine Canning Thoracic Institute’s Second Opinion Program, where she was told she was eligible for a transplant.

“The first thing Dr. Bharat told me on consultation was, ‘I can make you cancer-free,’” said Ameli, a retired nurse and grandmother of four. “These are the words every cancer patient wants to hear. I could not believe it. Even today, every day I wake up and I go, ‘I’m cancer free,’ and it’s unbelievable.”

She said the transplant has given her a new perspective on life. She now appreciates daily life more, even the snow and ice of Minnesota winters.

“Life has a different meaning now,” she said at the news conference, sitting side-by-side with Khoury. “Now, I look at the snow and go, ‘It’s so beautiful.’”

“Everything is beautiful,” Khoury added.

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