Northwestern Medicine study finds lung transplant dramatically improves survival for patients with terminal lung cancer
JAMA study challenges a long-held transplant rule that patients with stage IV lung cancer shouldn’t receive lung transplants
Chicago, IL – July 8, 2026 – A landmark study from the Northwestern Medicine Canning Thoracic Institute, published today in JAMA, suggests lung transplantation can significantly extend survival in select patients with advanced lung cancer.
In a study of patients with medically refractory, lung-limited stage IV non-small cell lung cancer (patients with terminal lung cancer confined to the lungs who are out of treatment options), Northwestern Medicine physicians and scientists found that lung transplantation was associated with substantially better early survival than medical management (chemotherapy, radiation, immunotherapy, etc.) alone.
The study, titled “Lung Transplant for Refractory Lung-Limited Stage IV Non-Small Cell Lung Cancer,” evaluated outcomes from the Double Lung Transplant Registry for Lung-Limited Malignancies – known as the DREAM registry – a pioneering Northwestern Medicine program designed to test whether replacing lungs overtaken by treatment-resistant cancer can remove organ-confined disease and rescue patients dying of respiratory failure. Northwestern Medicine is currently the only known health system in the country with a dedicated lung transplant program (DREAM) for patients with advanced lung cancers who have failed all other treatment options.
“This work changes what we can imagine for a highly selected group of patients who were previously considered beyond the reach of curative-intent intervention,” said co-corresponding author Ankit Bharat, MD, who is chief of thoracic surgery and director of the Canning Thoracic Institute. “We are not saying lung transplant is appropriate for every patient with stage IV lung cancer. We are saying that when the cancer is rigorously proven to be confined to the lungs, when standard therapies have been exhausted, and when the lungs themselves have become the life-limiting organ, transplantation may offer a new path forward.”
KEY RESULTS AT A GLANCE
- Study population: 404 adults with end-stage pulmonary disease, including 98 with stage IV lung cancer; 17 underwent lung transplant and 81 received medical management alone after nonbiologic barriers prevented transplant.
- Comparison with patients who did not receive transplant: In the main study period (September 2021 through June 2025), every transplanted patient was alive, while fewer than half of similar patients treated with medical therapy alone were alive.
- Comparison with patients who received lung transplant for lung failure from non-cancer causes: One-year posttransplant survival among lung transplant patients was 100% for those transplanted for stage IV lung cancer vs 88% for patients transplanted without cancer.
A devastating form of stage IV lung cancer
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.
Most patients with stage IV lung cancer have disease that has spread beyond the lungs. But a subset develops advanced non-small cell lung cancer that remains confined to the lungs, even as it progresses throughout both lungs and causes respiratory failure. These patients may exhaust targeted therapy, immunotherapy, chemotherapy and clinical trial options, yet still have no evidence of cancer outside the lungs. For these patients, the immediate cause of death is often not widespread systemic cancer, but progressive failure of cancer-filled lungs.
“This is a biologically distinct clinical scenario. These patients have stage IV cancer, but the disease remains anatomically limited to the lungs,” said co-corresponding author Young Kwang Chae, MD, MPH, who is a thoracic medical oncologist with the Robert H. Lurie Comprehensive Cancer Center of Northwestern University at Northwestern Memorial Hospital. “In these rare select group of patients, DREAM provides us a disciplined, scientifically rigorous way to ask whether removing the organ containing all visible disease can change the natural history of an otherwise fatal condition.”
What the study found
The JAMA study included 404 adults treated or evaluated at Northwestern Medicine from September 2021 through June 2025 for end-stage pulmonary disease.
Among 98 patients with stage IV lung cancer confined to the lungs, 17 underwent lung transplant and 81 met transplant eligibility criteria but didn’t undergo transplant because of nonbiologic barriers such as logistical, financial or geographic factors, and were treated with medical management alone.
The results showed 100% one-year survival among the 17 patients with stage IV lung cancer who received a lung transplant, compared to 41% one-year survival among the 81 patients with stage IV lung cancer who were treated with medical therapies alone.
The investigators also compared the lung cancer transplant recipients with 306 patients without cancer who underwent lung transplant for end-stage pulmonary disease such as cystic fibrosis, COPD or pulmonary hypertension. Between those two groups of patients, one-year posttransplant survival was 100% among the patients transplanted for stage IV lung cancer, versus 88% among lung transplant recipients without cancer.
“Any time we consider expanding the use or donor lungs, organ stewardship must be central. These results suggest that, in carefully selected patients and in the right multidisciplinary setting, lung transplantation for lung-limited malignancy can achieve early outcomes that are comparable to accepted noncancer transplant indications,” said Dr. Bharat.
Why this approach is different
Lung cancer has long been considered a relative contraindication to lung transplantation due to the concern that lung cancer would rapidly recur in the transplanted lung. The Northwestern Medicine team designed the DREAM trial to determine whether modern cancer detection methods could identify patients whose cancer was limited to the lung, limiting the chances of recurrence.
Patients underwent comprehensive contemporary staging to confirm that disease was confined to the lungs, including advanced imaging and systematic invasive mediastinal evaluation to reduce the risk of missing cancer spread outside the lungs. Transplant was considered only after patients had medically refractory disease despite available systemic therapies and consideration for clinical trials.
The surgical strategy was also redesigned to minimize the risk of cancer dissemination during the operation.
“This innovative technique involves putting the patient on 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 in 2020.”
The team also used single-cell transcriptomic analyses to study tumor regions across the removed lungs and investigate mechanisms of treatment resistance.
“Using state-of-the-art single-cell analysis of individual cancer cells from multiple regions of both cancer-filled lungs, we saw tumors that were profoundly resistant, with different cancer-cell populations relying on different resistance pathways. That helps explain why chemotherapy, immunotherapy and other systemic therapies could no longer meaningfully control the disease and why replacing the diseased lungs may be the only realistic option to extend life for these carefully selected patients,” said Dr. Bharat.
“The paradigm shift is not simply that transplant was performed for lung cancer. The shift is that transplantation was embedded within a complete scientific framework – rigorous staging, proof of lung-limited disease, transplant-specific operative innovation, intensive surveillance and molecular analysis of the explanted tumors. That is what makes this a new model of transplant oncology,” said co-corresponding author G.R. Scott Budinger, MD, chief of pulmonary and critical care medicine at the Canning Thoracic Institute.
Recovery, recurrence and next steps
Postoperative outcomes among the transplant recipients with cancer were generally similar to those among transplant recipients without cancer. Median hospital length of stay was 14 days for patients transplanted for stage IV lung cancer and 16 days for transplant recipients without cancer.
During follow-up, four of the 17 transplant recipients saw their cancer return and they were treated with local and systemic therapies (ex: surgery, radiation, chemotherapy, immunotherapy, etc.) By the end of the study in January 2026, two of the 17 transplant recipients had died.
The authors emphasize that longer follow-up is needed to define the durability of disease control, the risk of late recurrence and long-term quality of life after transplant.
“This is not a claim that transplant restores normal life expectancy, and it’s not a blanket indication for stage IV lung cancer. It’s evidence that a carefully selected group of patients facing otherwise poor near-term survival may have an opportunity for meaningful additional life – that’s why this work matters,” said Dr. Bharat.
About the DREAM Program
To date, Northwestern Medicine surgeons have performed more than 50 lung transplants for patients with advanced lung cancers.
Since Northwestern Medicine’s Lung Transplant Program first started in 2014, they’ve performed more than 700 lung transplant procedures for patients with end-stage lung diseases such as COVID, lung cancer, cystic fibrosis, chronic obstructive pulmonary disease (COPD) and more. Northwestern Medicine has one of the shortest wait times for a lung transplant in the U.S. with a median wait time of three days.
Patients interested in being evaluated for a lung transplant can contact the 24-hour referral line at 312.695.5864 or 844.639.5864. For more information about the Lung Transplant Program or lung cancer screenings, visit nm.org.
PATIENTS AVAILABLE FOR INTERVIEWS
David Peterson – Washington, DC
David Peterson is a freelance photographer who lives in Washington, DC. In early 2019, he developed a cough that wouldn’t go away, and after going to a local clinic, they discovered a dark spot on his lung. Peterson was diagnosed with lung cancer at a health system in Washington and started immunotherapy treatment, followed by surgery to remove a softball-sized tumor believed to have been developing on his left lung for more than a decade.
For nearly a year, Peterson’s recovery appeared promising, but a follow-up CT scan revealed his cancer had returned. Despite aggressive chemotherapy and multiple clinical trials, the disease continued to progress, and Peterson was running out of time.
In 2023, he discovered an online story about the DREAM Program at Northwestern Medicine, reached out to the lung transplant team and was fast-tracked for evaluation. Just weeks after being listed, and shortly after relocating to Chicago with the support of his wife and kids, Peterson received the call. On September 24, 2023, at the age of 57, Peterson underwent a double-lung transplant.
Now 60, he remains cancer-free and has had no signs of organ rejection. While managing a daily regimen of medications and ongoing physical rehabilitation, he’s embracing life again – reconnecting with his work as a freelance photographer, participating in lung transplant support groups and spending time with his family. His cancer, driven by a KRAS G12D gene mutation and unrelated to smoking, makes his case particularly noteworthy and he’s hopeful his story can raise awareness about emerging transplant options for patients with advanced lung cancer.
“When I first heard, ‘lung transplant,’ I thought it was too extreme to even consider, but it became my second chance at life. Today, I’m cancer-free, back with my family in DC, and picking up my camera again,” said Peterson. “I don’t take a single day for granted. This experience has taught me that even when options feel exhausted, there can still be hope – sometimes in places you never expected.”
Laura Rotunno – Deerfield, Illinois
For Laura Rotunno of Deerfield, Illinois, a lung transplant was a second chance at life after being diagnosed with lung cancer four years ago. Initially, the cancer started on her left lung, but after two years of chemotherapy, the cancer spread to her right lung. Facing limited treatment options, Rotunno’s physician recommended she reach out to Northwestern Medicine to be considered for the DREAM Program.
After an extensive transplant evaluation, and being hospitalized with pneumonia, Rotunno was placed on the lung transplant waiting list on May 20, 2025. Ten days later, at the age of 63, Rotunno underwent a successful double-lung transplant at Northwestern Memorial Hospital on May 30, 2025. Coincidentally, Rotunno’s transplant fell on the 11th birthday of her beloved German Shepherd, Koda.
Married to her husband, Richard, for 35 years and together for 45, Rotunno cherishes time with her family, including their 29-year-old daughter, Jenna. As she approaches her 65th birthday on July 31, Rotunno is back to working as a receptionist at a local health care system, and she reflects often on the anonymous donor who made her transplant possible.
“When I got the call that donor lungs were available, everything changed,” said Rotunno. “Just a few months earlier, I was in the hospital on oxygen, wondering what the future would hold. Now I wake up every day thankful for the simple things – a walk with my dog, time with my husband and daughter, and the chance to celebrate another birthday. My transplant is proof that one incredible act of generosity can change someone else’s life forever.”
Jodi Graf – Houston, Texas
For nearly three decades, Jodi Graf, a NASA engineer and mother of two, lived her life one breath at a time. In 1997, she began experiencing unexplained shortness of breath. Doctors in Houston, Texas, initially diagnosed her with asthma, prescribing an inhaler. But instead of improving, her condition worsened.
In 2005, after a bout of pneumonia, doctors identified a more serious condition – interstitial lung disease (ILD), which causes scarring of the lungs, making it difficult to breathe. For 10 to 15 years, Graf remained relatively stable until her health began to rapidly decline and she came to rely on supplemental oxygen.
In December 2023, Graf entered a formal lung transplant evaluation with doctors in Houston, but during the testing, they discovered a mass in her lungs. Despite not having a history of smoking, Graf was diagnosed with advanced lung cancer. At most transplant centers around the world, patients with active cancer are no longer eligible for lung transplants. Instead of being listed for a transplant in Houston, Graf underwent radiation treatment while her lung function dropped to 30 percent.
“Basic activities required constant supplemental oxygen – sometimes as much as 10 liters. Just walking from my car to my office at NASA was a feat,” said Graf. “I would Google ‘lung transplant’ constantly, searching for hope. That online search led me to news stories in Chicago about the DREAM Program and when I called Northwestern Medicine, I found my people.”
Last November, Graf arrived at Northwestern Memorial Hospital where she underwent a transplant evaluation and was listed for a double-lung transplant. Less than 24 hours after being placed on the wait list for new lungs, Graf received the call that a match was found, and her surgery took place on Thanksgiving Day – November 27, 2025.
After surgery, Graf walked on a treadmill – without oxygen – for the first time in years. She will reside in Chicago for one-year post transplant, and soon hopes to hike in Yellowstone, explore the Canadian Rockies, and travel with her husband, John, and their two sons, ages 22 and 26, without oxygen tanks for the first time in decades.
Tannaz Ameli – Minneapolis, Minnesota
Tannaz Ameli, a retired nurse living in Minneapolis, Minnesota, built a life in the United States after immigrating from Iran in 1980.
In September 2021, Ameli developed a persistent cough that steadily worsened. Initial testing, including a chest X-ray, led doctors to diagnose her with pneumonia. However, as her symptoms changed from a dry cough to a productive one, further imaging still pointed to pneumonia.
By January 2022, with no improvement, Ameli sought care at a large health system in Minnesota where she received a life-changing diagnosis: stage IV lung cancer. She started chemotherapy, but it quickly became clear that standard treatment would not be sufficient and Ameli was running out of time. After learning about Northwestern Medicine’s lung transplant program through media coverage, her husband, Medhi, arranged for a second opinion.
During a consultation with Ankit Bharat, MD, chief of thoracic surgery, Ameli learned she was a strong candidate for a lung transplant because her cancer remained confined to the lungs and had not spread to the lymph nodes.
Ameli traveled to Chicago and was admitted to Northwestern Memorial Hospital on July 3, 2022, where she was listed for a double-lung transplant. Just 10 days later on July 13, a donor was identified and Ameli, then 64, underwent a successful double-lung transplant. Four years later at the age of 68, Ameli remains cancer-free.
“As a nurse, I spent my life caring for others, and I never imagined I’d be the one relying on such extraordinary care,” said Ameli. “When I came to Northwestern Medicine, the first thing Dr. Bharat told me was, ‘I think we can make you cancer-free,’ and he delivered on those words. If you or a loved one has lung cancer, Northwestern Medicine is the place to be. These days, I’m enjoying traveling, spending time with friends and family and living proof that there is hope even in the most difficult moments.”
Contact
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Jenny Nowatzke Program Director, Media Relations Northwestern Memorial Hospital Pulmonology and Lung Surgery, Cancer, Infectious Diseases |