‘Am I dreaming?’: Double lung transplants save two people with advanced cancer


Two people with stage IV lung cancer who had been told they had weeks or months to live are breathing freely after double lung transplants, Northwestern Medicine in Chicago said Wednesday.

Lung cancer is the leading cause of cancer-related death in the United States. The American Cancer Society estimates that more than 127,000 Americans will die from the disease this year.

It is considered stage IV once additional tumors have developed in the lungs in addition to the primary tumor, or the cancer has spread to more organs.

Someone diagnosed with stage IV lung cancer has limited treatment options, says Northwestern Medicine. A double lung transplant offers a potentially life-saving option for some people with a poor prognosis, but doctors say there are specific criteria a lung cancer patient must meet, including that the cancer is in the lungs and that the person has tried all other treatment options.

In 2020, 54-year-old Albert Khoury of Chicago received a devastating diagnosis of lung cancer.

Khoury, a cement finisher for the Chicago Department of Transportation, began experiencing back pain, sneezing and chills, along with coughing up blood, according to Northwestern Medicine. It was almost the beginning of the Covid-19 pandemic, so at first he thought he had coronavirus-related symptoms.

Shortly thereafter, he was diagnosed with stage I lung cancer.

Due to the pandemic, Khoury did not start treatment until July 2020. At that point, the cancer had progressed to stage II and continued to grow, eventually reaching stage IV. He was told to consider hospice, special care for people at the end of their lives, focused on comfort and support.

“I had a few weeks to live,” Khoury said in a video released by the hospital. “Not that much time.”

His sister suggested that he contact Northwestern Medicine about the possibility of a double lung transplant.

“I need new lungs. That’s the only hope for life,” Khoury told his doctor.

He met with a Northwestern Medicine oncologist, who told him to try additional treatments first. But not long after, he was admitted to intensive care with pneumonia and sepsis.

As his health deteriorated, oncologists began considering the rarely used procedure.

“His lungs were full of cancer cells and day after day his oxygen was dropping,” said Dr. Young Chae, a medical oncologist at Northwestern Medicine who helped treat Khoury.

Transplantation is usually considered for people with lung cancer that has not spread to other parts of the body and for those who have tried all other treatment options and have little time left to live, said Dr. Ankit Bharat, head of the thoracic surgery department. at Northwestern Medicine Canning Thoracic Institute, which helped treat Khoury.

William Dahut, head of scientific research for the American Cancer Society, also noted the importance of ensuring that cancer does not spread to other parts of the body before performing a transplant.

“There should be as much certainty as possible that the cancer is confined to the lungs, so whatever kind of extensive screening tests should be done … to make sure there are no cancer cells outside the lungs,” said Dahut, who was not involved in the care of either Northwestern patient.

The oncologists decided that Khoury was a candidate for the procedure. In September 2021, he underwent surgery for about seven hours.

“Surgeons had to work extremely meticulously to prevent trillions of cancer cells from the old lungs from entering Khoury’s chest cavity or his bloodstream,” Northwestern Medicine noted in a press release.

The operation is not without risks, Bharat said. In people with late-stage cancer, there is always a chance that it will return after the procedure.

“There’s definitely the risk that they’re in a worse situation than they were,” he said. “So you have major surgery, and then the cancer can come back very quickly.”

Another risk is the treatment needed after a transplant, Dahut said.

All lung transplant recipients must take medications to weaken their immune systems, which reduces the chances of their bodies rejecting the organ, but also reduces their ability to fight infection, according to the National Cancer Institute.

“Drugs that actually suppress your immune system put you at risk for infection afterwards, but may even put you at risk for second cancers afterwards,” Dahut said.

However, 18 months later, Khoury has had no more complications and is back to work.

His doctor showed him an X-ray of his chest with no signs of cancer. “When I saw that X-ray, I believed him,” Khoury said. “My body is now in my hands.”

The procedure was put to the test again last year, this time with a 64-year-old woman from Minnesota.

Tannaz Ameli, a retired nurse from Minneapolis, had a persistent cough for months. Her doctors took a chest X-ray and diagnosed her with pneumonia.

The illness continued until she was diagnosed with stage IV lung cancer in January 2022.

“There was no hope for my life at that point. They gave me… three months,” Ameli said in a video released by Northwestern Medicine.

She underwent unsuccessful chemotherapy treatments and was told to consider hospice.

“I had no hope. I was ready for the end of my life,” she said.

But her husband contacted Northwestern Medicine about the possibility of a transplant. The oncologists found that Ameli met their criteria, and in July she received a double lung transplant.

When she was told the procedure had made her cancer-free, she wondered, “Am I dreaming of sitting here?” Can it happen?’ And it happened.”

Ameli has had no complications and she said the procedure has given her a new outlook on life.

“Every morning when I open my eyes, I just can’t believe it,” Ameli said. “Life has a different meaning now.”

Double lung transplants for cancer are rare because of concerns that the cancer could come back, Bharat said.

Historically, the surgery required consecutive transplants, but they’re trying to change the approach to reduce the risk of recurrence, he said.

“What usually happens in a double lung transplant is we take out one lung, put the new one in, then take out the second lung and put the second lung in,” he said. “The concern is that when you take one lung out and put in a new lung, the other lung is still stuck and they could cross-contaminate. … You could inadvertently allow the cancer cells to spread into the bloodstream.

If cancer cells cross-contaminate or enter the bloodstream, there is a greater risk of cancer coming back.

Bharat and his team took a different approach with Khoury and Ameli: they opened the chest cavity and performed a full heart and lung bypass.

“Essentially what that means is we don’t have blood going through the heart and lungs and bypass all of that,” Bharat said. “That allows us to stop blood flow to the lungs, preventing cancer cells from entering the bloodstream from the lungs.”

The surgeons gave Khoury and Ameli lung-shaped friendship necklaces on Wednesday to mark their success.

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