November 2022

GASTROENTEROLOGY

COMPLEX CASE REPORT: THE FIRST COMBINED LUNG-LIVER TRANSPLANT AT NORTHWESTERN MEDICINE

Northwestern Medicine physicians have successfully collaborated on and performed the health system’s first successful combined lung-liver transplant. Ankit Bharat, MD, chief of Thoracic Surgery at Northwestern Medicine Canning Thoracic Institute, performed the lung transplant, and Satish Nadig, MD, PhD, chief of organ transplantation, and Juan Caicedo Ramirez, MD, transplant surgeon, performed the liver transplant. Rade Tomic, MD, pulmonologist and medical director of the Northwestern Medicine Lung Transplant Program, cared for the patient before and after surgery.

The patient, 63-year-old Patricio Collera of Vernon Hills, Illinois, is a retired nurse who worked at Northwestern Memorial Hospital for several years before being diagnosed with interstitial lung disease and nonalcoholic liver disease, which caused scarring of the lungs and liver cirrhosis. Less than 10 days after being added to the waitlist for new organs, Collera received the call in August that a new lung and liver were available.

“A lung-liver transplant procedure is very rare. To date in the United States, only 10 have been performed in 2022,” says Dr. Tomic. “Patricio was in desperate need of a lung, and we didn’t have much time to keep waiting for a double-lung transplant. The outcomes of a single-lung transplant versus a double-lung transplant are very similar, so we decided to proceed with one lung because it was an excellent match.”

​In 2017, Collera developed a terrible cough, and by 2019, his breathing was so bad that he relied on supportive oxygen 24/7 and had to stop working. “My life was miserable. I had to drag 50 feet of tubing and oxygen tanks with me everywhere I went. One tank would only last 30 minutes, so I’d have to bring two tanks with me to the grocery store,” Collera says. 

In February 2022, Collera was evaluated for a lung transplant, and testing showed his liver was fibrosed by 75%. This meant Collera would also need a liver transplant to withstand the transplant medications he’d be on for the rest of his life.

“I immediately sent messages across the country to top-tier transplant centers and was informed that a lung-liver transplant wasn’t possible due to my age or their team’s lack of experience. One doctor told me, ‘Don’t do it — you’re going to die,’” says Collera. “But when I turned to Northwestern Medicine, I started crying tears of relief when they said, ‘Yes — we can do it.’” 

Collera was listed for a double-lung and liver transplant on August 15, and on August 24, he received the call that a single-lung and liver were available. Even though he was listed for a double-lung transplant, the team encouraged him to take the organs. Once Collera was in the operating room, surgeons were in a race against the clock.

“With two different organs, you have to work twice as fast. You can’t start the second transplant until the first is completed and perfect. There’s zero margin of error. Many people are working closely to make this a success: lung team, liver team, anesthesiologists, nurses, perfusionists, donor team. It’s an elegant and closely coordinated dance,” says Dr. Bharat. “Patricio’s lung transplant was the fastest one I’ve ever done in my career, and the new lung is working great. In fact, his old left lung, new right lung and new liver are all very happy together.”

“Transplant is the ultimate team sport, and honestly, it’s one of the only fields I can think of that depends on humanity. Somebody has to give up their organs, either in life or in passing, to save someone else -- often, someone they don’t know,” says Dr. Nadig. “With all the things happening in the world, it’s not only amazing to be able to replace someone’s lung and liver and they go on to live a normal life, but to also know we’re honoring the gift that someone has given up themselves.”​​

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