Surgeons perform first simultaneous double-lung, kidney transplant in Illinois, Wisconsin

Dec 17 2008

Eric McCabe of Wausau, Wis., had no earth-shaking plans for the future as he began his recovery from the rare double-lung and kidney transplant surgery he had at Loyola University Medical Center in Maywood, Ill.

He didn't want to fly a high-performance aircraft, travel to faraway, exotic locales or climb Mount Everest.

All McCabe wanted was to do what he's doing more than 22 months after his surgery -- enjoying the quiet, simple life he enjoyed before his health began spiraling downwards five years ago from the cystic fibrosis he was diagnosed with as a child.

“Getting back to work and to doing what I used to do, that's all I was looking forward to,” said McCabe, who is doing well after being the first person in Illinois and Wisconsin to undergo the rare multiple-organ transplant. “People take that so much for granted, but for more than a year-and-a-half, I hadn't done much except spend time in the hospital.”

Today, McCabe, 28, is back to living his simple life. He has his own apartment in Weston, Wis., works part-time and attends classes at the University of Wisconsin-Wausau.

Simple, however, is not something that can be said of the unique and complex operation that McCabe underwent in March 2007. Since 1995, only 10 people in the United States have undergone the surgery with most of those involving a single lung, according to the United Network for Organ Sharing, which oversees the national waiting list.

“It's a huge, technical operation. I've done several single lung-kidneys but no one had ever done a double-lung-kidney in this region,” said the man who performed the lung portion of McCabe's 10-hour procedure, Dr. Robert Love, professor and vice chair of thoracic and cardiovascular surgery and surgical director, lung transplant, Loyola University Chicago Stritch School of Medicine, Maywood, Ill.

Dr. Love first met McCabe three years ago when he was the director of the heart/lung transplant program at the University of Wisconsin, Madison. There McCabe was evaluated and listed for transplant surgery.

“When I left, they were unable to treat him any longer because they didn't have the expertise to do a case like that," said Love, who came to Loyola in September 2007. "He was left in limbo. They told him they couldn't treat him and then de-listed him. We jumped through a lot of hoops and eventually got him listed here for transplant.”

Multiple-organ transplants carry special risks. There are infections and the added stress caused by additional incisions to the body. Also, if the patient loses too much blood during the double-lung transplant, it could delay or make it impossible to perform the next transplant. In McCabe's case, his surgery was made even riskier because his failing kidneys required that he be on dialysis.

“Furthermore, I had to dialyze him while I was doing the transplant,” Love said. “He was very ill. He had pneumonia, two clotting abnormalities and a deficiency of a certain factor in his bloodstream. He was getting multi-system organ failure and was being dialyzed every other day. He was on his last legs. He was only going to live a few weeks in the state he was in.”

In McCabe's case, time was of the essence due to his numerous health problems, any of which could have cost him his life during the surgery.

“It's a long operation and you don't want to make it too long. We thought about putting the kidney on the pump and doing it the next day because a double-lung transplant is such a huge operation,” Love said, “but I was able to get him through the operation without using the bypass machine. So we kept going, which is much better for the kidney.”

The kidney and lungs for McCabe's transplants were from the same donor, an important consideration in Love's decision to go through with the procedure.

“I had had many offers for Eric when I was in Wisconsin but it was always the lungs without the kidney,” Love said. “It's really important to get the organs from the same donor because it's the same antigens. You're not exposing his immune system to two donors' antigens.”

Dr. David Holt, associate professor of surgery, intra-abdominal transplant surgery, Stritch School of Medicine, performed the kidney transplant on McCabe following Dr. Love's operation. Though his end of the procedure was “technically straightforward,” the operation did provide its own particular difficulties.

“Part of the difficulty of doing something like this is: No. 1, it's not done very often. No. 2, it requires two separate teams that needs to coordinate things,” Holt said. “In general, the thoracic transplant guys are separate from the abdominal transplant guys. We don't work with them directly very often. We have to be able to agree on what's going to work for everybody.”

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