Historic Quadruple Organ Transplant – AMJ

A QUADRUPLE organ transplant combining retransplanted lungs, a liver, and a kidney has been successfully completed.

The first known U.S. procedure of its kind was performed in a 36-year-old woman with cystic fibrosis who developed chronic rejection following an earlier double lung transplant. The operation replaced both lungs for a second time while also transplanting a donor liver and kidney.

Registry data indicated that this was the first quadruple organ transplant in the U.S. involving retransplanted lungs. Only seven quadruple organ transplant procedures had previously been performed nationally.

Quadruple Organ Transplant Addresses Multiple Organ Failure

The recipient underwent her first double lung transplant in 2017 and initially regained her quality of life. However, her health deteriorated in early 2026 after she developed restrictive allograft syndrome, a rare and frequently fatal form of chronic lung transplant rejection.

Further evaluation identified liver and kidney failure associated with complications of cystic fibrosis. Progressive respiratory failure ultimately required mechanical ventilation and extracorporeal membrane oxygenation, or ECMO.

She was admitted to a cardiothoracic intensive care unit on March 17 and listed for the quadruple organ transplant on March 19. Four donor organs became available three days later.

Redo lung transplantation is particularly challenging because previous surgery can produce dense scar tissue and significantly distort normal chest anatomy. These changes increase the likelihood of bleeding and injury to surrounding organs and blood vessels. Transplanting four organs also creates additional concerns surrounding infection and organ rejection.

Machine Perfusion Supports Surgical Coordination

The double lung retransplantation began on the evening of March 22, followed by the liver and kidney transplants during the early hours of March 23.

Machine perfusion technology was used to preserve the liver and kidney outside the body while thoracic surgeons completed the more technically complex lung procedure. This reduced the time pressure associated with conventional cold storage and allowed the surgical teams to work sequentially.

Close coordination among thoracic and abdominal transplant surgeons, anesthesiologists, intensive care specialists, perfusionists, and nurses enabled implantation to be completed in approximately eight hours. The liver and kidney began functioning when blood flow was restored.

Recovery After Lung Retransplantation

The transplanted lungs, liver, and kidney were functioning well following surgery. The recipient was discharged less than three weeks later and continued rebuilding her strength through walking and light weightlifting.

By July, she was walking approximately 3 to 4 miles each day and preparing to return home to Iowa to reunite with her 11-year-old son.

The case demonstrates how machine perfusion, multidisciplinary planning, and coordinated transplant expertise may expand treatment possibilities for carefully selected people with complex multiorgan failure.

Reference
Northwestern Medicine. Northwestern Medicine performs first known quadruple-organ transplant involving retransplanted lungs. July 14, 2026. Available at: Last accessed: July 15, 2026.

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