VUMC performs its first combined lung and liver transplant – VUMC Reporter

Transplant patient Connie Rankin was cleared to return home to Memphis just in time for the holidays. (photo by Erin O. Smith)

by Matt Batcheldor

Vanderbilt University Medical Center recently performed its first combined lung and liver transplant.

Connie Rankin of Memphis, Tennessee, received the transplant, which involved dozens of specialists, including transplant teams for both organs. Her lung transplant was performed by Matthew Bacchetta, MD, MBA, professor of Cardiac Surgery and Biomedical Engineering; and her liver transplant was performed by Seth Karp, MD, H. William Scott Jr. Professor and chair of the Section of Surgical Sciences.

Rankin said she was diagnosed in 2001 with sarcoidosis, a rare autoimmune disease that causes excess tissue to develop in organs of the body. It affected both her liver and lungs. Her lung function got worse over the years, but she was able to live with it until 2022, when she contracted COVID-19, and her breathing became much worse. Doctors estimated she had two years to live if she didnt get a transplant. She was at end stage when we met her for the first time, Bacchetta said.

Her liver was also failing, and her eyes were yellow with jaundice.

Rankin had a big decision whether to become the first person to undergo a lung-liver transplant at Vanderbilt. She knew the risks but talked at length about the possible benefits with Eric Lambright, MD, associate professor and surgical director of the Lung Transplant Program. She was on medical oxygen, she noted. It occurred to me there is the possibility that the surgery could be successful, and then I could once again breathe in room air like normal people, remarked Rankin.

VUMC placed her on the transplant list in May 2023 and she began waiting for the gift of lungs and a liver from a deceased organ donor. The wait could have been months, because the donor would have to match her size and blood type and other factors.

Having been on the waiting list only 24 hours, Rankins phone rang. Her matching organs were available. She knew she needed to hit the road for Nashville, but she was awestruck.

I sat there an hour, and I had to get my mind right, she said. I was praying, and I was like OK, well, Lord, you know, you brought me to it. So, Im going to trust you to bring me through it. And from that point on, all the fear left me. And Im like, I know that I am at one of the top hospitals in the country with some of the best doctors.

With trust in God and confidence in the medical staff at Vanderbilt, Rankin arrived in Nashville.

Days after the life-changing phone call, she learned some of the details of the complicated transplant. Surgeons first removed one of her lungs and placed her on ECMO (extracorporeal membrane oxygenation), a life-sustaining mechanical system that temporarily takes over for the heart and lungs of critically ill patients. Then the liver team completed her liver transplant, while her donor lungs were preserved in a new, special laboratory-grade refrigerator. Bacchetta said the refrigerator allows organs to be preserved for up to 20 hours, a major increase from the typical eight hours, allowing for longer and more complex multi-organ transplants.

After the liver transplant was complete, the lung team completed its transplant.

There arent many institutions that could do that well and provide this type of outcome for her, Bacchetta said.

This case really shows the Vanderbilt Transplant Centers commitment to our patients, using a multidisciplinary approach to offer personalized care and achieve the best outcomes, said Martin Montenovo, MD, MMHC, chief of the Division of Hepatobiliary Surgery and Liver Transplantation in the Department of Surgery. We have the resources, we have the expertise, and we have the innovation to make complex transplants successful.

In all, due to complications, Rankin would have five different surgeries over a weekend. Her kidneys shut down, and she had to go on dialysis. She had an unexpected tracheotomy due to a need for oxygen.

Two weeks later, when the tracheotomy tube was removed, she initially didnt realize she was breathing room air, not medical oxygen.

I felt like I was born again or something, she said. It was just amazing to me not being attached to the oxygen. I could move freely about. Even now Im just still amazed.

During her stay at Stallworth Rehabilitation Hospital, her kidney function returned, and she no longer needed dialysis.

After leaving the hospital, Rankin recovered at an apartment in Nashville. The week before Thanksgiving, she was cleared to return home to Memphis, just in time for the holidays.

There are more milestones to accomplish, and my healing continues, but life is so much better already, Rankin said.

I had an awesome team, the nurses, the doctors, the therapists and my caregivers, she said. Im just so grateful.

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VUMC performs its first combined lung and liver transplant - VUMC Reporter