Kentucky father with terminal lung cancer now cancer-free after innovative double-lung transplant at Northwestern Medicine
Surgeons at Northwestern Medicine utilized “lungs in a box” technology to repair donor lungs that were not immediately suitable for transplant, saving the life of a man with terminal lung cancer who couldn’t afford to wait for an ideal match
CHICAGO – April 23, 2024 – For the first time at Northwestern Medicine, surgeons have used a solution to clear blood clots from the donor lungs of a patient with terminal lung cancer in urgent need of a double-lung transplant. The patient, 63-year-old Keith Zafren of Lexington, Ky., had rapidly progressing stage 4 lung cancer and was running out of time to find a suitable match. To save his life, surgeons with the Northwestern Medicine Canning Thoracic Institute took donor lungs that were not initially viable for transplant and used ex vivo lung perfusion (AKA “lungs in a box”) to keep the organs alive outside the body. While on that system, surgeons used clot-busting drugs to repair the lungs before transplanting Zafren on Aug. 3, 2023. The former pastor, small business owner, and father of three is the sixth patient to receive a double-lung transplant through a first-of-its-kind clinical program at Northwestern Medicine called Double Lung Replacement and Multidisciplinary Care (DREAM). The program was formally established in March 2023 to provide hope for select patients with stage 4 lung cancers confined to the lungs who are being considered for hospice. Eight months after surgery, Zafren’s new lungs are working well and he does not require any further cancer therapy.
“Keith’s transplant demonstrates how far we can push our technologies to help patients, including some patients with terminal lung cancer whose disease is rapidly progressing,” said Ankit Bharat, MD, chief of thoracic surgery and executive director of the Canning Thoracic Institute. “Given the urgency of Keith’s situation, we took a set of lungs that would not have been usable in normal circumstances. These organs were donated by someone who had blood clots in their legs that had traveled to their lungs. Using ex vivo lung perfusion, we were able to use specific enzymes to clear those blood clots while the lungs functioned outside the body. Keith is now cancer-free and his donor lungs are working beautifully. He is a testament to what is possible for some patients who are out of treatment options and, therefore, out of hope.”
In December 2017, Zafren, a non-smoker, was busy running his painting and remodeling business in Lexington, Ky., when he fell ill with a persistent cough and fever. His doctors confirmed a diagnosis of pneumonia, but his chest x-ray revealed additional cause for concern – two masses in the upper and lower lobes of his left lung. After an exploratory bronchoscopy in April 2018, Zafren was diagnosed with advanced lung cancer. He had surgery to remove half of his left lung, followed by two different kinds of chemotherapy, but conventional treatments failed. Cancer cells continued to spread throughout his airways, ravaging both lungs.
“I felt like we were essentially waiting for me to get worse and die,” said Zafren. “But my wife, Lori, told me to hold on. She told me to live as long as I can because even though they’re telling us we’re out of options now, you never know what’s coming down the pike. There’s new science, new medicines, new procedures and, repeatedly, that was true, the longer I survived.”
In 2021, Zafren joined a clinical trial for a drug that works to slow the growth of cancer cells in patients with his type of cancer. While the medication initially shrunk his tumors, on Aug. 2, 2022, Zafren was blindsided by the news that the drug had stopped working and his tumors were beginning to re-grow. His doctors told him that with palliative chemotherapy, he might only have two years to live.
“After that meeting with the oncologist, where he told us this is the end, I had already heard about what was happening at Northwestern Medicine. I had seen a news clip about the first late-stage lung cancer patient who had received a double-lung transplant. His cancer was limited only to his lungs, he was out of all other options and I thought, ‘That sounds like me.’”
In November 2022, Zafren got in touch with physicians at the Canning Thoracic Institute who pre-qualified him for the DREAM program and continued to monitor his disease. By the spring, Zafren’s lungs were failing and he was coughing incessantly, requiring multiple liters of supplemental oxygen a day. On April 17, 2023, he was transferred to Northwestern Memorial Hospital in Chicago where his medical team confirmed his eligibility for the DREAM program and listed him for a double-lung transplant.
“Like our first DREAM patient, Albert Khoury, Keith’s lung cancer was characterized by a lepidic growth pattern, meaning his cancer cells spread throughout the lungs’ small airways rather than forming a ball-like nodule or mass,” said Young Chae, MD, medical oncologist at Northwestern Medicine. “On a CT scan, this type of cancerous tumor looks almost indistinguishable from pneumonia. Keith’s cancer involved both lungs, making it a stage 4 cancer, but the disease did not spread outside the lung tissue. This made him an ideal candidate for our DREAM protocol.”
After two months on the donor recipient list without a suitable offer for new organs, Zafren’s medical team moved forward with their approach to repair a set of donor lungs that would otherwise be unsuitable for transplant. Exactly one year after he was told that his cancer was incurable, Zafren’s phone rang with the news he had been waiting for.
“We got the death sentence on August 2, 2022, in Lexington. One year later, on August 2, 2023, our Northwestern Medicine transplant nurse called and told us to come to the hospital. They had new lungs for us and it was just divine,” said Zafren.
While at Northwestern Memorial, Zafren joined an online support group of over 25 double-lung transplant recipients consisting of both DREAM and non-DREAM patients. Given his background as a pastor and experience leading small groups, Zafren asked several men from the larger support circle if they wanted to begin meeting as a smaller network. The men held their first meeting on Oct. 25, 2023, and the group eventually grew to eight patients.
“The guys really love meeting and sharing, talking about things we would not feel comfortable sharing in a larger, mixed-gender group,” said Zafren. “I’m so happy to organize and facilitate our meetings. I love these men. I love supporting them, encouraging them to support each other, and sharing topics for discussion at each meeting.”
“Keith’s dedication to nurturing a support network for other patients based on his own journey fills me with immense pride as his physician,” said Catherine Myers, MD, pulmonologist with the Canning Thoracic Institute. “A lot of these men are from a generation where it’s not common to talk about conflicting feelings after experiencing a surgery like this, but these are important conversations to have. Many transplant recipients experience anxiety, depression, or other mental health concerns. Keith’s background as a pastor really set him up to provide an outlet where men can express the challenges of transplant that are hard for others to understand.”
Less than two weeks after his life-saving surgery, Zafren left the hospital to continue his recovery at a temporary home in Chicago with his wife, Lori Friesen, PhD. In addition to monthly check-ins with his support group, Zafren maintains a healthy lifestyle by walking at least ten miles each week, strength training six days a week and playing golf regularly. He’ll remain in Chicago through the summer to be closely monitored by his transplant team.
“Thanks to the incredible care I received at Northwestern Medicine, I feel better than I have in six years since my lung cancer diagnosis,” said Zafren. "I could not be more happy or grateful for these beautiful donor lungs breathing for me every day.”
April is National Donate Life Month, a time to appreciate organ donors and their loved ones who have given the gift of life, while encouraging others to register as organ, eye and tissue donors. Currently, nearly 104,000 people in the United States are waiting for an organ transplant. One organ donor can save up to eight lives.
MORE INFORMATION THE DREAM PROGRAM
To date, the Canning Thoracic Institute (CTI) has performed more than 40 lung transplants for patients under the DREAM program, including one combined double-lung and liver transplant 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.
“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 Ankit Bharat, MD, chief of thoracic surgery and director of the Northwestern Medicine Canning Thoracic Institute. “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. To date, the Northwestern Medicine Canning Thoracic Institute is the only place in the nation offering this treatment for patients without any other hope.
“It’s the dream. It’s why it’s called the DREAM study,” said Friesen. “What they’re doing here at Northwestern Medicine is hope dealing. When you’re facing death, all you have is hope and angels who happen to wear surgical masks.”
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.