July 6, 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.
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.
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.
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).
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.
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.
After recovering in the hospital for 51 days and undergoing a novel procedure to fight graft-versus-host disease, the patient has fully recovered with no evidence of cancer recurrence.