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#United States, August 13, 2022 – The Cleveland Clinic has successfully performed the world’s first complete multi-organ transplant to treat a patient with a rare form of appendix cancer called pseudomyxoma peritonei (PMP). At the end of the life-saving transplant surgery, the patient received five digestive organs: liver, stomach, pancreas, duodenum and small intestine.

Anil Vaidya, MD, co-director of the Cleveland Clinic Intestinal Transplant Program, led the team of seven surgeons who completed the pioneering operation on a 32-year-old man in September 2021.

“The patient had one of the most advanced cases of PMP I have seen,” Dr Vaidya said. “While about 80% of patients with the condition can be treated with traditional therapies, what do you do with the 20% for whom traditional therapy is not effective? In some cases, the answer may be a multi-organ transplant.

During the 17-hour operation, surgeons removed the patient’s diseased organs. He then received the following organs from the deceased donor all together and at the same time: liver, stomach, pancreas and duodenum (pancreaticoduodenal complex), spleen, small intestine and right colon. The donor spleen was initially transplanted to enhance the immune protection of newly transplanted organs and improve blood flow to the pancreas until complete transplantation. The donor’s right colon was initially transplanted to help protect the new intestine from infection and improve its ability to absorb nutrients. The donor spleen and the donor right colon were removed before the end of the transplant after successfully serving to protect the other organs during the operation.

“As far as we know, this is the first time in the world that a complete transplant of multiple organs, including the liver and four other digestive organs, has been performed to treat PMP,” Dr Vaidya said.

Prior to joining the Cleveland Clinic in 2020, Dr. Vaidya performed the world’s first modified multi-organ transplant (excluding the liver) in England to treat a patient with PMP who had exhausted all other management strategies. charge.

PMP is a rare cancer that usually originates as a tumor in the appendix. When the slowly growing tumor ruptures, its gelatinous contents spread to other digestive organs, with the development of additional tumors that impair gastrointestinal function. Malnutrition and life-threatening complications eventually occur.

Following the diagnosis in 2019, the patient began a long odyssey of treatments. He was one of the 20% of patients with PMP for whom traditional treatments were ineffective. Often, this patient population is left with few or no treatment options.

The patient was referred to the Cleveland Clinic in 2021 with terminal illness. He was receiving palliative care at the time. The patient had stopped working and could no longer eat solid foods. He was receiving nutrients intravenously through total parenteral nutrition (TPN).

“We needed to carry out an assessment to determine if the transplant in her case was safe, feasible and could provide long-term benefits,” Dr Vaidya said.

Dr. Vaidya performed a thorough assessment of the patient’s case and received approval from the Cleveland Clinic Intestinal Transplant Screening Committee to proceed. The patient was placed on the national transplant waiting list in July 2021.

“The patient – who needed a liver and four other digestive organs – had started deteriorating quite rapidly,” Dr Vaidya said. “It was a touch-and-go that he would get there.”

In September 2021, a donor was found, and less than 24 hours later, the patient was undergoing the inauguration

operation. The first three hours were preparatory, essentially removing diseased abdominal organs. Then, the donor organs were inserted into the abdominal cavity, all necessary vascular connections were completed, and a left-sided ileostomy was created to manage bodily waste and let the body recover from surgery.

“The operation was well planned and went like clockwork,” said Dr Vaidya. “The team members knew exactly what they were going to do and the timing was perfect. It went very well.

After the transplant, the patient remained in the hospital for 51 days. Shortly after his discharge, he returned because he was suffering from a case of graft-versus-host disease, a common occurrence following bowel or bone marrow transplants where immune cells from donated organs recognize the recipient’s tissues as foreign and attack the recipient.

The patient underwent a procedure perfected and performed by Amy Lightner, MD, colorectal surgeon and director of the Cleveland Clinic Center for Regenerative Medicine and Surgery. Dr. Lightner administered three doses of mesenchymal stromal cell (MSC)-derived exosomes, a pioneering first ever treatment in solid organ transplants – another first for a patient who received a full multi-organ transplant to treat the PMP.

According to Dr. Vaidya, “The patient’s recovery was absolutely amazing. Her symptoms subsided within two hours of the first dose.

Nine months after the transplant, the patient, now 33, can eat and digest solid food again and has the energy to do what he loves, including walking and cycling outside.

“There is currently no evidence of cancer recurrence,” Dr Vaidya said.

Photo captions:

On your mind: Masato Fujiki, MD, (center) and the Cleveland Clinic surgical team, led by Anil Vaidya, MD, perform the world’s first multi-organ transplant to treat a rare type of appendix cancer. (Photo courtesy of Cleveland Clinic)

1st insert: Anil Vaidya, MD

2nd insert: Left to right: Anil Vaidya, MD, Shannon Jarancik, physician assistant, Amy Lightner, MD, Andy Voge, patient, Rachel Voge, Andy’s wife, and Anita Barnoski, transplant coordinator.

Exit: Cleveland Clinic / DPA Media

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