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Cleveland Clinic Performs First-In-World Full Multi-Organ Transplant to Treat Rare Appendix Cancer

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#USA, August 13, 2022 – Cleveland Clinic has successfully performed a first-in-the-world full multi-organ transplant to treat a patient with a rare form of appendix cancer called pseudomyxoma peritonei (PMP). Upon completion of the lifesaving transplant surgery, the patient received five digestive organs: liver, stomach, pancreas, duodenum, and small intestine.

Anil Vaidya, M.D., Cleveland Clinic’s Intestinal Transplant Program co-director, led the seven-surgeon team that completed the pioneering operation on a 32-year-old man in September 2021.

“The patient had one of the more advanced cases of PMP I have seen,” said Dr. Vaidya. “While about 80% of patients with the condition can be treated with traditional therapies, what do you do with the 20% for whom the traditional therapy isn’t successful? 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 deceased donor’s organs 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 boost the immune protection of the newly transplanted organs and improve blood flow to the pancreas until fully transplanted. The donor right colon was initially transplanted to help protect the new intestine from infection and improve its ability to absorb nutrients.  Both the donor spleen and donor right colon were removed prior to the completion of the transplant after they successfully served to protect the other organs during the operation.

“As far as we know, it is the first time in the world that a full multi-organ transplant, including the liver and four other digestive organs, is performed to treat PMP,” said Dr. Vaidya.

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

PMP is a rare cancer that typically originates as a tumor in the appendix. When the slow-growing tumor ruptures, its jelly-like content spreads to other digestive organs, with additional tumors developing that impair gastrointestinal function. Malnutrition and life-threatening complications ultimately 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 the traditional treatments were ineffective. Often, this population of patients is left with few to no treatment options.

The patient was referred to Cleveland Clinic in 2021 in the end stage of his disease. He was receiving hospice care at that 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 perform an evaluation to determine if transplantation in his case was safe, feasible and could provide long-term benefits,” said Dr. Vaidya.

Dr. Vaidya completed a thorough assessment of the patient’s case and received approval from Cleveland Clinic’s Intestinal Transplant Selection 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 to deteriorate quite rapidly,” said Dr. Vaidya. “It was touch-and-go that he would make it.”

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

surgery. The first three hours were preparatory, in essence removing the diseased abdominal organs. Next, the donor organs were inserted into the abdominal cavity, all the necessary vascular connections were completed and a left-sided ileostomy was created to handle bodily waste and let the body recover from the 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 really well.”

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

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

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

Nine months post-transplant, the patient, now 33, can eat and digest solid foods again and has energy to do what he loves, including walking and biking outdoors.

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

 

Photo Captions: 

Header: Masato Fujiki, MD, (center) and the Cleveland Clinic surgical team, led by Anil Vaidya, MD, performing the first-in-world multi-organ transplant to treat a rare type of appendix cancer. (Photo courtesy of Cleveland Clinic)

1st insert: Anil Vaidya, M.D.

2nd insert: From left: Anil Vaidya, M.D., Shannon Jarancik, physician assistant, Amy Lightner, M.D., Andy Voge, patient, Rachel Voge, Andy’s wife, and Anita Barnoski, transplant coordinator.

Release: Cleveland Clinic / DPA media

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Bahamas News

PMH Dialysis Unit Gets Boost with Donation of 6 New Machines

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#TheBahamas, September 27, 2022 – The Princes Margaret Hospital (PMH) Dialysis Unit received a significant boost as it officially took possession of six (6) donated dialysis machines on Wednesday.  The donation of six (6) Fresenius 2008T Hemodialysis Machine with Bibag for Hemodialysis treatments was facilitated by Coral Pharmaceuticals Limited, representative for Renal Dynamics in the Bahamas.

Dyalisis Machines Donation Sept. 2022

The donation supports the need for dialysis machines for the Princess Margaret Hospital Dialysis Unit; especially considering the age of the existing equipment. Each device has the capacity to treat an estimated three (3) patients per day.

Making the presentation on behalf of Renal Dynamics was Mr. Nicholas Schweickert, Director of Operations. Renal Dynamics supports Dialysis Clinics / Units throughout the region and has done so for more than twenty-five (25) years. Renal Dynamics sells and supports hemodialysis machines, supplies and peritoneal dialysis products as well as facilitates training programs.

The refurbished equipment is valued at over $60,000.00 USD which includes not only delivery, shipping, and installation, but also training for nurses.

Receiving the dialysis machines on behalf of the hospital were PHA Chairman Mr. Andrew

Edwards, Deputy Managing Director. Dr. Keva Thompson, Director of PHA Foundations Mrs. Alana Major, Hospital Administrator Ms. Mary Lightbourne-Walker, and Assistant Director Supplies Management Agency Ms. Shavonne

Dyalisis Machines Donation Sept. 2022

Burrows. Sister Darnell Roker, Nurse Manager of the Dialysis Unit also attended the official handover representing the PMH Dialysis team.

Also present were Paul Bevans (Director) and Shenika Taylor (CEO) of Coral Pharmaceuticals Limited.

Chairman Edwards expressed the PHA’s and the Dialysis Unit’s gratitude to the representatives of Coral Pharmaceuticals and Renal Dynamics for the generous donation. He noted the ongoing support by Renal Dynamics demonstrates the necessity of private entities partnering with the PHA to enhance the quality of care offered.

The donated machines will replace some of the older equipment currently in use and will provide vital back-up for the remaining machines within the unit.

 

Photo Caption: L-R, Alana Major, Paul Bevens, Nicholas Schweickert, Keva Thompson, Andrew Edwards, Darnell Roker, Shavonee Burrows, Shenika Taylor

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Africa

Nearly 400 tested as Uganda faces deadly Ebola resurgence

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By Deandrea Hamilton & Dana Malcolm

Editorial Staff

 

#Uganda, September 27, 2022 – Uganda has declared an Ebola outbreak after 23 confirmed deaths from the virus and at the case fatality rate revealed at 64 per cent.  There are at least 34 others infected with the disease.

The Health Ministry in Uganda has intensified messages and information on the signs and symptoms of the disease; a help hotline has also been established, said the commissioner of surveillance.

The World Health Organization shared news of the outbreak last week, citing cases of the Sudan ebolavirus was confirmed in Uganda’s Mubende district.

The interventions in the district have brought new fears to the country as quarantines are government managed and can last up to 21 days; already 13 people have escaped prompting continued concern of a mushrooming of case numbers.

Uganda has been largely free of the deadly disease for over a decade, the last outbreak was declared in 2012.

The Sudan Ebolavirus has a very high death rate and in previous outbreaks it has varied between 40 to 100 per cent.

The 2014-2016 outbreak affected Guinea, Sierra Leone and Liberia most, causing thousands of casualties.

Named after the Ebola River in The Democratic Republic of Congo where it was first found the virus spreads between human to human and human to animal contact. Earlier this year the DRC has a small outbreak caused by animal to human contact.

Media reports now indicate medical professionals have gone on strike at a hospital where several cases were detected; the nurses, pharmacists and trainee doctors have accused the government of not providing sufficient safety against possible infection.

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Health

Omicron Boosters, what they mean for Turks and Caicos Islands inventory of Vaccines

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By Dana Malcolm

Staff Writer

 

#TurksandCaicos, September 18, 2022 – The Turks and Caicos Islands may be forced to dump boosters whether people want to take them or not if the UK follows the FDA’s lead on ‘updated boosters’.

During August the US Food and Drug Administration approved the emergency use of bivalent vaccines from Moderna and Pfizer as updated booster shots.  The shots have two components one that protects against the original covid19 strain and one that protects against Omicron BA.4 and BA.5.

But what the agency also did was rescind its emergency use approval for the original monovalent boosters. Those boosters were the same formula as the original vaccines which means they were made to fight the initial strain of Covid and had limited efficacy against omicron and its variants.

The Turks and Caicos received thousands of those doses from the UK over the past nine months.

Now that there are several bivalent vaccines including ones that protect against Omicron and the BA.5/4 variants specifically the FDA has determined that there is no need for the original boosters. Those boosters, depending on who made them, are eligible to be used as primary doses for people who have never had a shot to prevent waste but the majority of the TCI population have already had their primary doses.

Over the course of the COVID-19 pandemic the UK has been one of the front runners in approving and using cutting edge treatments to protect people from the disease. They have already approved the bivalent that fights the original strain of omicron

If the UK gives Moderna and Pfizer the nod and puts a ban on the old boosters the doses may have to be dumped.

Based on the extremely low booster uptake, that would mean thousands of doses down the drain.

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