“Am I dreaming? ‘: Double lung transplants save two people with terminal cancer


Two people with stage IV lung cancer who were told they only had weeks or months to live are breathing freely after receiving 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 grown in the lungs, apart from the primary tumor, or the cancer has spread to other organs.

A person diagnosed with stage IV lung cancer has limited treatment options, according to 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 patient with lung cancer must meet, including that the cancer is contained within the lungs and 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 having back pain, sneezing and chills, as well as coughing up blood, according to Northwestern Medicine. It was around the start of the Covid-19 pandemic, so at first he thought he had symptoms related to the coronavirus.

He was diagnosed with stage I lung cancer shortly thereafter.

Due to the pandemic, Khoury did not begin treatment until July 2020. By then, the cancer had progressed to Stage II and was continuing to grow, eventually reaching Stage IV. She was told to consider palliative care, special care for people at the end of life that focuses on comfort and support.

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

Her sister suggested she contact Northwestern Medicine about the possibility of a double lung transplant.

“I need new lungs. It’s the only hope to live,” Khoury told his doctor.

He met with an oncologist from Northwestern Medicine, who told him he should try additional treatments first. But soon after, he was admitted to the intensive care unit with pneumonia and sepsis.

As her health declined, oncologists began considering the rarely used procedure.

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

Transplant is generally considered for people with a form of 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 to live, according to Dr. Ankit Bharat, Chief of Thoracic Surgery. at the Northwestern Medicine Canning Thoracic Institute, which helped treat Khoury.

William Dahut, scientific director of the American Cancer Society, also stressed the importance of ensuring that cancer does not spread to other parts of the body before doing a transplant.

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

Oncologists decided Khoury was eligible for the procedure. In September 2021, he spent around seven hours in surgery.

“Surgeons had to be extremely meticulous not to allow billions of cancer cells from the old lungs to spill into Khoury’s chest cavity or into his bloodstream,” Northwestern Medicine noted in a press release.

The surgery is not without risk, Bharat said. In people with advanced stage cancer, there is always a chance that it will come back after the procedure.

“There is certainly the risk of potentially being in a worse situation than them,” he said. “So you have a big surgery and then you could very quickly bring the cancer back.”

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

All lung transplant recipients must take medication to suppress their immune system, which helps reduce the chance that their body will reject the organ — but also decreases its ability to fight infection, according to the National Cancer Institute.

“Drugs that actually suppress your immune system put you at risk for infection later on, but could even put you at risk for a second cancer later on,” Dahut said.

However, 18 months later, Khoury has had no 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 in my hands now.”

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

Tannaz Ameli, a retired nurse from Minneapolis, had a persistent cough for several months. His doctors did a chest x-ray and diagnosed him with pneumonia.

The illness persisted until she was told she had stage IV lung cancer in January 2022.

“There was no hope for my life at that time. They gave me… three months,” Ameli said in a video posted 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 option of a transplant. Oncologists found Ameli fit their criteria and she received a double lung transplant in July.

When told that the procedure had freed her from cancer, she wondered, “Am I dreaming, sitting here? Can this happen? And it happened.

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

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

Double lung transplants for cancer are rare due to fears the cancer will come back, Bharat said.

Historically, the surgery required sequential transplants, but they are looking to modify the approach to reduce the risk of recurrence, he said.

“Usually what happens in a double lung transplant procedure is that we remove one lung, insert the new one, then remove the second lung and insert the second lung,” he said. “The problem is that when you remove one lung and put in a new one, the other lung is still attached and they could become contaminated. …you could inadvertently spread cancer cells into the bloodstream.

If cancerous cells become contaminated or enter the bloodstream, the risk of cancer recurrence is higher.

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, that means we don’t let any blood go through the heart and lungs and bypass all of that,” Bharat said. “This then allows us to stop blood flow to the lungs, which will prevent cancer cells from moving from the lungs into the bloodstream.”

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

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