For the first time at Northwestern Medicine, surgeons have successfully performed a combined lung-liver transplant on a patient with advanced lung cancer who had limited time to live. The patient, 69-year-old 

, a pulmonologist, allergist and immunologist from Santa Monica, Cali., was diagnosed with stage 3 lung cancer in March 2023. After undergoing chemotherapy, radiation and immunotherapy at a California hospital, Dr. Gibbon was admitted to the intensive care unit, where he learned the immunotherapy had not only permanently destroyed his lungs, but also caused irreparable damage to his liver. His only option for survival would be traveling to Chicago for a combined lung-liver transplant, where a first-of-its-kind clinical program called 

Double Lung Replacement and Multidisciplinary Care (DREAM)

 was established for select patients with advanced lung cancers that do not respond to conventional treatments. In September 2023, Dr. Gibbon received his new lungs and liver from the same donor, and six months after surgery, Dr. Gibbon still has no signs of cancer in his body and doesn’t require any further cancer therapy.

“To our knowledge, this is the first known case in the nation where a patient with advanced lung cancer has successfully received a combined lung-liver transplant,” said 

, chief of thoracic surgery and director of the 

Northwestern Medicine Canning Thoracic Institute

 who performed Dr. Gibbon’s lung transplant. “The purpose of DREAM is to help patients with some forms of late-stage cancers that are only limited to the lungs through double-lung transplantation if conventional or experimental treatments have failed. In Dr. Gibbon’s case, he received all possible treatments for his aggressive lung cancer. Unfortunately, not only did his cancer not get treated, but he also developed severe damage to his lungs and liver that was unsustainable with life. He was running out of time, and the DREAM program was his only option for survival.” 

“Even though a combined lung-liver transplant for advanced lung cancer had never been done before, our team was confident we could do this, and more importantly, Dr. Gibbon had full confidence in us,” said 

, transplant surgeon and director of the 

Northwestern Medicine Comprehensive Transplant Center

 who performed Dr. Gibbon’s liver transplant. “We’re not just here to do transplant – we’re here to change the world of transplantation by innovating and moving the field forward. Out-of-the-box thinking is exactly what we hang our hat on at Northwestern Medicine, and without this procedure, I can confidently say that Dr. Gibbon would not be here today, cancer-free, breathing on his own, celebrating his 69th birthday.”

Originally from Cape Town, South Africa, Dr. Gibbon moved to Santa Monica where he was in 

 for 33 years until his recent hospitalization. He’s also an associate professor at 

. In March 2023, Dr. Gibbon started coughing and losing weight; a chest X-ray confirmed a mass with a diagnosis of stage 3 lung cancer. He proceeded with chemotherapy, immunotherapy and radiation, and by mid-July he was hospitalized with septic shock, pneumonia and multiple organ failure. His lungs had become fibrotic due to the cancer treatment, and he was fighting for his life in a Los Angeles intensive care unit.

“As a pulmonologist, I never imagined I’d ever need a lung transplant – let alone for lung cancer,” said Dr. Gibbon. “While my doctors in California had done everything they could, we knew there was only one place in the entire country that could give me a fighting chance, and after speaking with Dr. Bharat, I could see the light at the end of the tunnel.”

“Dr. Gibbon met the criteria to receive a double-lung transplant through our DREAM program, but as the preliminary evaluation was performed prior to his acceptance to Northwestern Medicine, our team discovered that he had also developed liver cirrhosis from the immunotherapy. We had to modify our DREAM program and work with Dr. Nadig’s team to formulate a pathway for Dr. Gibbon to receive not only a double-lung transplant, but a concurrent liver transplant. Fortunately, we were able to do it just in time for Dr. Gibbon to receive this first-of-its-kind procedure,” said Dr. Bharat.

On Sept. 10, the then 68-year-old was transported to Chicago via a four-hour medical flight and waited for new organs from his ICU bed at 

. After spending 12 days on the transplant waitlist, Dr. Gibbon received his new lungs shortly before midnight on Sept. 26, and his new liver in the early hours on Sept. 27.

Drs. Bharat and Nadig worked together during the 10-hour procedure. While the new lungs were put in first, the donor liver was kept alive outside the body thanks to new technology called 

 – or “liver in a box.” The liver was attached to a machine that pumps warm, oxygenated and nutrient-enriched blood through the organ. With the liver was on the pump, the team could assess its function to ensure the liver was ideal for transplantation.

“Transplantation is ever evolving and we’re embarking upon the era of technology. Dr. Bharat anticipated that the lung transplant would be extremely challenging due to the size of Dr. Gibbon’s tumor and the different types of treatments, including radiation, to the lungs and chest which would result in the lungs getting fused to the surrounding structures. To give Dr. Bharat sufficient time to meticulously remove the damaged lungs and all the cancer, we used the new liver perfusion technology through which we were able to keep the liver alive outside the body for an extended duration,” said Dr. Nadig. “Dr. Gibbon’s transplant took so many resources and teams across multiple departments at multiple health systems. To leave his ICU bed in California, travel to Chicago, get him listed, then transplanted, while using technologies and techniques that aren’t common, took extreme efforts. Northwestern Medicine handles complicated cases very well.”

To date, the Canning Thoracic Institute (CTI) has performed more than 30 lung transplants for patients under the DREAM program, including several with terminal stage IV lung cancer and one in which cancer from another organ had spread to the lungs. Using lessons learned from 

 in the United States, CTI surgeons developed the novel surgical technique to clear the cancer during surgery while minimizing the risk of spread that has plagued prior such attempts at other hospitals.

“Unlike the conventional technique of sequential transplants, this innovative technique involves putting the patient on full heart and lung bypass, delicately taking both cancer-ridden lungs out at the same time along with the lymph nodes, washing the airways and the chest cavity to clear the cancer, and then putting new lungs in,” said Dr. Bharat. “These patients can have billions of cancer cells in the lungs, so we must be extremely meticulous to not let a single cell spill into the patient’s chest cavity or blood stream. We believe this technique can help reduce the risk of recurrence, which we learned through our experience with pioneering COVID-19 lung transplants.”

The outcomes of the program’s patients are being tracked in a research registry also called 

. Dr. Gibbon is grateful to have his name added to the list and is even more appreciative to celebrate his birthday (March 27) and National Doctors’ Day (March 30) with two of the physicians who helped save his life. To date, the Northwestern Medicine Canning Thoracic Institute is the only place in the nation offering this treatment for patients without any other hope.

“I’ve been a physician for decades, and we tend to be conservative at times with our treatment plans, which is why the enormity of the science that went into this procedure is awe-inspiring to me,” said Dr. Gibbon. “As a physician, I knew I was in the right place. I wasn’t just stepping on the moon by myself. It took surgeons, oncologists, transplant specialists, nurses, respiratory therapists and most importantly, my donor, to help me get my ‘Triple L’ – two lungs and a liver. This DREAM program is new territory for transplantation and the fact that I could experience it and have a wonderful outcome makes me feel so blessed. I wouldn’t be here today without Northwestern Medicine.”

“Because Dr. Gibbon is a pulmonologist and allergy specialist, he’s familiar with lung diseases, which made this case even more special,” said Dr. Bharat. “As physicians helping another physician, we feel very proud that we were able to do something that hopefully opens the doors for future patients who would otherwise not survive.”

Cancers of the lung are the leading cause of cancer-related deaths in the United States with more people dying of lung cancer than colon, breast and prostate cancers combined. Lung cancer patients interested in being evaluated for a lung transplant can contact the 

 at 844.639.5864. For more information about Northwestern Medicine’s transplant programs, as well as advanced therapies, visit 

Articles

Gary Gibbon, MD, pulmonologist and allergist, visited Chicago for a first-of-its-kind transplant procedure, becoming the first person in the U.S. to receive a double-lung and liver transplant for advanced lung cancer.



California Doctor Receives Northwestern Medicine’s First Combined Lung-Liver Transplant for Advanced Lung Cancer

A new artificial intelligence (AI) tool may make it possible to spare breast cancer patients unnecessary chemotherapy treatments by using a more precise method of predicting their outcomes, reports a new Northwestern Medicine study.

AI evaluations of patient tissues were better at predicting the future course of a patient’s disease than evaluations performed by expert pathologists.

The AI tool was able to identify breast cancer patients who are currently classified as high or intermediate risk but who become long-term survivors. That means the duration or intensity of their chemotherapy could be reduced. This is important since chemotherapy is associated with unpleasant and harmful side effects such as nausea, or more rarely, damage to the heart.

Currently, pathologists evaluate cancerous cells in a patient’s tissue to determine treatment. But patterns of non-cancerous cells are very important in predicting outcomes, the study showed.

This is the first study to use AI for comprehensive evaluation of both the cancerous and non-cancerous elements of invasive breast cancer.

“Our study demonstrates the importance of non-cancer components in determining a patient’s outcome,” said corresponding study author Lee Cooper, PhD, associate professor of pathology at Northwestern University Feinberg School of Medicine. “The importance of these elements was known from biological studies, but this knowledge has not been effectively translated to clinical use.”

In 2023, about 300,000 U.S. women will receive a diagnosis of invasive breast cancer. 

About one in eight US women will receive a breast cancer diagnosis in their lifetime

During diagnosis, a pathologist reviews the cancerous tissue to determine how abnormal the tissue appears. This process, known as grading, focuses on the appearance of cancer cells and has remained largely unchanged for decades. The grade, determined by the pathologist, is used to help determine what treatment a patient will receive.

Many studies of breast cancer biology have shown that the non-cancerous cells, including cells from the immune system and cells that provide form and structure for the tissue, can play an important role in sustaining or inhibiting cancer growth.

Cooper and colleagues built an AI model to evaluate breast cancer tissue from digital images that measure the appearance of both cancerous and non-cancerous cells, as well as interactions between them.

“These patterns are challenging for a pathologist to evaluate as they can be difficult for the human eye to categorize reliably,” said Cooper, also a member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. “The AI model measures these patterns and presents information to the pathologist in a way that makes the AI decision-making process clear to the pathologist.”

The AI system analyzes 26 different properties of a patient’s breast tissue to generate an overall prognostic score. The system also generates individual scores for the cancer, immune and stromal cells to explain the overall score to the pathologist. For example, in some patients, a favorable prognosis score may be due to properties of their immune cells, where for others it may be due to properties of their cancer cells. This information could be used by a patient’s care team in creating an individualized treatment plan.

Adoption of the new model could provide patients diagnosed with breast cancer with a more accurate estimate of the risk associated with their disease, empowering them to make informed decisions about their clinical care, Cooper said.

Additionally, this model may help in assessing therapeutic response, allowing treatment to be escalated or de-escalated depending on how the microscopic appearance of the tissue changes over time. For example, the tool may be able to recognize the effectiveness of a patient’s immune system in targeting the cancer during chemotherapy, which could be used to reduce the duration or intensity of chemotherapy.

“We also hope that this model could reduce disparities for patients who are diagnosed in community settings,” Cooper said. “These patients may not have access to a pathologist who specializes in breast cancer, and our AI model could help a generalist pathologist when evaluating breast cancers.”

The study was conducted in collaboration with the American Cancer Society (ACS) which created a unique dataset of breast cancer patients through their Cancer Prevention Studies. This dataset has representation of patients from over 423 U.S. counties, many whom received a diagnosis or care at community medical centers. This is important because most studies typically use data from large academic medical centers which represent only a portion of the U.S. population. In this collaboration, Northwestern developed the AI software while scientists at the ACS and National Cancer Institute provided expertise on breast cancer epidemiology and clinical outcomes.

To train the AI model, scientists required hundreds of thousands of human-generated annotations of cells and tissue structures within digital images of patient tissues. To achieve this, they created an international network of medical students and pathologists across several continents. These volunteers provided this data through a website over several years to make it possible for the AI model to reliably interpret images of breast cancer tissue.

Next, the scientists will evaluate this model prospectively to validate it for clinical use. This coincides with the transition to using digital images for diagnosis at Northwestern Medicine, which will happen over the next three years.

The scientists also are working to develop models for more specific types of breast cancers like triple-negative or HER2-positive. Invasive breast cancer encompasses several different categories, and the important tissue patterns may vary across these categories.

“This will improve our ability to predict outcomes and will provide further insights into the biology of breast cancers,” Cooper said.

Other Northwestern authors include Mohamed Amgad Tageldin, Kalliopi Siziopikou, and Jeffery Goldstein.

A new artificial intelligence tool may make it possible to spare breast cancer patients unnecessary chemotherapy treatments by using a more precise method of predicting their outcomes.

Robert H. Lurie Comprehensive Cancer Center of Northwestern University Northwestern Medicine

Articles

California Doctor Receives Northwestern Medicine’s First Combined Lung-Liver Transplant for Advanced Lung Cancer

AI May Spare Breast Cancer Patients Unnecessary Treatments