September 27, 2023

VUMC performs novel reoperative lung and kidney transplant

Vanderbilt University Medical Center has performed its first combined reoperative lung and kidney transplant.

Nicole Hunter was the first patient to receive the novel transplant. (photo by Erin O. Smith)
Nicole Hunter was the first patient to receive the novel transplant. (photo by Erin O. Smith)

Vanderbilt University Medical Center has performed its first combined reoperative lung and kidney transplant.

Nicole Hunter, 36, of Searcy, Arkansas, received the transplant, which took place over 17 hours and involved dozens of specialists, including transplant teams for both organs. Her lung transplant was performed by Matthew Bacchetta, MD, MBA, professor of Surgery; and Chetan Pasrija, MD, assistant professor of Cardiac Surgery. Laura Hickman, MD, assistant professor of Surgery, performed the kidney transplant. The anesthesiologists were Meredith Kingeter, MD; Matthew Barajas, MD; Mias Pretorius, MD; and fellow Robert Barnes, MD.

This was Hunter’s second lung transplant. She was born with cystic fibrosis, a chronic lung condition that resulted in her being in and out of the hospital regularly since birth. In 2011, her local doctors referred her to Vanderbilt, and she received a lung transplant in 2013.

Afterward, for the first time, Hunter could breathe normally, and she did so for the better part of 10 years. It was only last fall that her breathing began to decline, and fast. She was hospitalized, and it was determined she had chronic rejection of her lungs and would need a repeat lung transplant. During this time, she developed acute kidney injury that required dialysis for a brief time.  She was able to come off dialysis but was noted to have irreversible damage to her kidneys and would also need a kidney transplant.

“It was a little scary because I hadn’t really had any kidney issues, so I didn’t really know what to expect,” Hunter said. “And so all that was very unique to me. I’ve never had dialysis before, so I didn’t know how that worked.”

Hunter found herself in the unusual situation of needing a lung and a kidney at the same time. But a simultaneous transplant of both these organs is rare; only 131 lung/kidney transplants have been performed since 1995, said Hunter’s nephrologist, Heidi Schaefer, MD, professor of Medicine and medical director of Adult Solid Organ Transplant.

After two weeks in the hospital following her transplant, Hunter is recovering in Nashville. She said she feels great after her dual transplant and recently walked a mile during pulmonary rehab. So far, she has had no rejection issues.

“Being a part of Nicole’s team was a great privilege,” said Hickman, the surgeon who performed Hunter’s kidney transplant. “It takes many physicians, nurses, staff and other supporters to offer dual organ transplants to patients, and we are lucky to have such a team at Vanderbilt. We are excited to offer combined lung kidney transplants to patients in the Southeast and beyond. Many people don’t realize how disruptive dialysis is to someone’s life; it makes having a job, traveling and many other activities difficult due to the time commitment. A kidney transplant allows patients to focus on other things that are important to them, and we are immensely grateful for her donor and all the other organs donors that help our patients every day.”

Hunter said she has no regrets for all the five-hour drives she and her family have made from her home in Arkansas to Vanderbilt over the last 12 years.

“We’re definitely glad we chose Vanderbilt,” she said. “I wouldn’t trust my health to anybody else, because we have nothing but good things to say about Vanderbilt and how they’ve taken care of me. I truly don’t feel like I would be here without Vanderbilt.”

Schaefer said the dual lung-kidney transplant, while rare, might be a sign of things to come.

“Our ability to perform these transplants sets us apart from many other transplant centers in the region and allows us the opportunity to transplant complex patients who might not be able to be transplanted elsewhere.”

Bacchetta, also surgical director of the Vanderbilt Lung Institute, said, “We will see continued growth in dual organ transplant in the coming years. What makes this case unique is the fact that it was a lung re-transplant plus kidney. It is uncommon to perform reoperations in lung transplant, but Vanderbilt has taken on that increased challenge with great success.”