Innovations: Lung Transplant

The Vanderbilt Transplant Center has performed its first lung transplant on a patient with lung cancer, and she is now cancer free.

Carole Taylor, 48, of Nashville, Tennessee, said it all started with stiffness and soreness in her right shoulder. “It was growing increasingly stiff and got to where I couldn’t really move it,” she said. “And then I started having really painful muscle spasms in my right shoulder.”

One day, the pain grew so bad that Taylor went to orthopaedic urgent care in Durham, North Carolina, where she was living at the time. As she was about to move back to her hometown of Nashville, a doctor there referred her to a Vanderbilt University Medical Center pulmonologist, Fabien Maldonado, MD, MSc, professor of Medicine and Thoracic Surgery.

Maldonado performed a biopsy which resulted in a diagnosis: non-small cell lung cancer. “It was surreal,” Taylor recalled. Her brother had died of the same cancer in 2017. “It was hard on me. I’m a single mom with two children. It was hard for my children and hard for my whole family because we had been through this.”

Maldonado referred Taylor to the Vanderbilt-Ingram Cancer Center. She started receiving chemotherapy every three weeks, but a transplant wasn’t initially presented as an option. A lung transplant had never been performed on a patient for lung cancer at Vanderbilt before.

It didn’t occur to Taylor that it was an option until she had a conversation with her best friend, a nurse in Atlanta, who had a relative pass away who was an organ donor. That sparked a question in her mind, and she discovered that another medical center had transplanted lung cancer patients.

“I hadn’t heard of that at all, so I looked into it,” Taylor said. She was referred to the Vanderbilt Transplant Center and Matthew Bacchetta, MD, MBA, professor of Surgery and surgical director of the Vanderbilt Lung Institute. He was honest: He couldn’t guarantee anything. But, after a discussion with David Erasmus, MD, associate professor of Surgery and medical director of Lung Transplant, she would move forward with an evaluation to determine if she would be listed for transplant. “I was excited and hopeful,” she said.

Transplanting a cancer patient is a delicate balance. Immunotherapy and chemotherapy must be discontinued for a period before transplant to prevent organ rejection issues. But if it is discontinued for too long, the cancer spreads, and a transplant is not possible. Caitlin Demarest, MD, PhD, assistant professor of Thoracic Surgery and associate surgical director of Lung Transplant, performed a procedure to ensure it was safe to list Taylor for transplantation.

This year Taylor was at work as director of college counseling at St. Cecilia Academy in Nashville when she got the news that she was listed for transplant. She remembers getting the call that her new lungs were available the evening of New Year’s Day, 2024, when she was in the kitchen baking a cake.

She came to VUMC the next day for her transplant and remembers the moment just before anesthesia was administered, then remembers waking up in the ICU with two new lungs. Demarest and Bacchetta performed her lung transplant. 

“We carefully orchestrated this complex transplant to ensure strict adherence to oncologic principles and transplant practices — a delicate balance,” Demarest said. She also noted that few transplant centers in the world perform such procedures.

Taylor’s anesthesiologist was Frederick Lombard, MBChB, associate professor and chief of Cardiothoracic Anesthesiology.

There were a couple of bumps in Taylor’s road to recovery. She caught COVID-19 shortly after her transplant. She learned to breathe again on her own after her time on oxygen, growing stronger week by week.

Three months after her procedure, she was released from rehab, cancer free. Her lung function is great, she said.

“I’m really amazed, truly amazed by the progress I’ve made in the first three months,” she said. “The respiratory therapist and rehab are just amazing. The whole transplant team, they’re just wonderful. Everybody has been so wonderful.”

She credits not only her providers, but a very supportive community at St. Cecilia as well as her primary caregivers, her son Issac, 21, and daughter Sophia, 18.

“I’m just thankful every day,” she said. “When you go through a journey like this, you really learn to truly live in the present and be grateful for every moment that you feel well, every day that I’m able to spend with my children and my family. You just don’t take things for granted.”