California doctor receives Northwestern Medicine’s first combined lung-liver transplant for advanced lung cancer

Dr. Gibbon's transplant team

CHICAGO – March 28, 2024 – 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 Gary Gibbon, MD, 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 Ankit Bharat, MD, 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 Satish Nadig, MD, PhD, 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 69^th birthday.”

Dr. Gibbon at work

Originally from Cape Town, South Africa, Dr. Gibbon moved to Santa Monica where he was in private practice for 33 years until his recent hospitalization. He’s also an associate professor at UCLA’s David Geffen School of Medicine. 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 Northwestern Memorial Hospital. 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.

Arrived in Chicago

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 liver perfusion – 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 pioneering COVID-19 lung transplantation 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.

Drs. Nadig and Bharat in the operating room

“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 DREAM. 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 referral line at 844.639.5864. For more information about Northwestern Medicine’s transplant programs, as well as advanced therapies, visit nm.org.