#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.
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
No More Weekly COVID Updates, says WHO
September 29, 2023 – In a clear sign that the global community has moved past the emergency stage of the COVID-19 Pandemic; the World Health Organization (WHO) is suspending its weekly COVID updates and migrating to a monthly format.
In a September 1 report, they advised: “Please note that this is the last edition of the COVID-19 Weekly Epidemiological Update. Moving forward, as WHO transitions its COVID-19 surveillance from an emergency response to long-term COVID-19 disease prevention, control and management, we will be providing updates every four weeks.”
The WHO, along with other health agencies like the US Centers for Disease Control, had been warning about the reduced reliability of COVID-19 data because of less robust testing worldwide for some time.
The disease was downgraded from a Public Health Emergency of International Concern in May 2023.
New boosters are still being approved and the WHO is predicting that the disease will have to be controlled with yearly vaccines as variants continue to emerge much like the Flu virus.
COVID + Kids, What to watch for
September 29, 2023 – COVID-19 is no longer a Public Health Emergency of International Concern, but the disease is still present and can still affect the population including children.
Cough fever and difficulty breathing are only some of the symptoms that young children and babies might experience when infected with the viral illness, according to a report from Johns Hopkins Medicine.
Other symptoms include muscle or body aches; sore throat; loss of taste or smell; diarrhea; headache; fatigue; nausea or vomiting; congestion or runny nose.
Children may not be eloquent enough to properly convey their illness so parents are advised to pay close attention to their complaints and visible symptoms.
Though COVID-19 can be a mild disease for most, there are some cases that warrant immediate emergency medical attention the hospital says. These include:
- Difficulty breathing or catching his or her breath
- Inability to keep down any liquids
- confusion or inability to awaken
- Bluish lips
Both COVID and the flu tend to spike during the winter flu season so parents are advised to take precautions against them including mask wearing in high risk areas and frequent hand washing.
New report reveals stunning Blood Pressure statistics
#TurksandCaicos, September 29, 2023 – Hypertension affects 1 in 3 adults worldwide, and if countries do not scale up coverage tens of millions of people will die. That’s according to a first-of-its-kind report on the global effects of hypertension from the World Health Organization.
The September 19th report indicated that the number of people living with hypertension has doubled in less than 30 years, between 1990 and 2019, from 650 million to 1.3 billion and nearly half of the affected are unaware.
The WHO is now calling on all countries including the Turks and Caicos to invest in the prevention, detection and management of hypertension as a matter of urgency.
The organization crunched the numbers to show countries what more focused programs could do.
“An increase in the number of patients effectively treated for hypertension to levels observed in high-performing countries could prevent 76 million deaths, 120 million strokes, 79 million heart attacks, and 17 million cases of heart failure between now and 2050,” it said.
Along with saving lives, the WHO says it can also decrease spending on health. Health is usually the largest portion of the TCI budget. The cost of preventing and managing the disease versus treating its effects is massive.
“The prevention, early detection and effective management of hypertension are among the most cost-effective interventions in health care and should be prioritized by countries as part of their national health benefit package offered at a primary care level. The economic benefits of improved hypertension treatment programs outweigh the costs by about 18 to 1.”
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