Northwestern Conducts First Quadruple-Organ Transplant with Retransplanted Lungs

Northwestern Medicine in Chicago has successfully conducted the first known quadruple-organ transplant involving retransplanted lungs in the United States, as detailed in a news release on July 14. The recipient of this complex surgery is 36-year-old Elizabeth Wehrle from Montezuma, Iowa, who required a rare transplant of new lungs, a liver, and a kidney due to multiple health challenges. After rejecting her initial lung transplant performed in 2017 and suffering further damage from cystic fibrosis, Ms. Wehrle faced an urgent need for this extensive medical intervention.

1. Elizabeth Wehrle is recognized as the first individual in the U.S. to receive a quadruple-organ transplant that includes retransplanted lungs, as stated by the Scientific Registry of Transplant Recipients. With this surgery, Northwestern becomes the sixth U.S. medical program to carry out a quadruple-organ transplant, but notably the first to do so with retransplanted lungs. Nationwide, only a total of seven quadruple-organ transplants have been completed.

2. The complications from Ms. Wehrle’s prior 2017 double-lung transplant, conducted at a different health system, resulted in dense scar tissue that significantly distorted the normal anatomy of her chest, making subsequent surgeries riskier. Ankit Bharat, MD, who is the chief of thoracic surgery and executive director of Northwestern Medicine’s Canning Thoracic Institute, explained that surgical maneuvers are fraught with risks, including potential bleeding and injury to surrounding organs and blood vessels. This risk increases when multiple organs are involved, heightening the chance of organ rejection and serious infections.

3. Following a bout of illness that began in January, Ms. Wehrle was diagnosed with restrictive allograft syndrome by late February. This chronic rejection condition is particularly perilous, to the extent that many transplant centers avoid repeat lung transplantation due to the associated risks. In addition, cystic fibrosis had already caused significant damage to her liver and kidney. By the time she consulted Northwestern, she was in progressive respiratory failure and required support from a ventilator and extracorporeal membrane oxygenation (ECMO).

4. To enhance safety, the surgical teams approached the procedure with a two-part method. Thoracic surgeons commenced with the lung retransplant on March 22, followed by an abdominal team performing the liver and kidney transplant hours later. The surgical procedures altogether stretched over eight hours. Chitaru Kurihara, MD, surgical director of the lung transplant program at the Canning Thoracic Institute, articulated that attempting a singular, extended 20-hour surgery would have imposed excessive stress on a critically ill patient.

5. To allow surgeons more time for the procedures, Northwestern employed machine perfusion technology to maintain the functionality of the donor organs outside the body, which extends the operational window past traditional cold storage limits, reducing time pressure for the teams during surgery.

6. Remarkably, Ms. Wehrle was discharged from the hospital in under three weeks post-surgery. She has since resumed light weightlifting and walks daily for three to four miles. She is set to return to Iowa on July 17, where she will reunite with her 11-year-old son. Northwestern’s lung transplant program, established in 2014, has successfully performed over 700 lung transplants, boasting a median wait time of just three days, placing it among the shortest in the nation.