Cleveland Clinic Performs First-In-World Full Multi-Organ

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

Global health system Cleveland Clinic has successfully performed a first-in-theworld 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 most advanced cases of PMP I have seen,” said Dr. Anil 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 abdom-

Dr. Anil Vaidya

UPON COMPLETION OF THE LIFESAVING TRANSPLANT SURGERY, THE PATIENT HAD RECEIVED FIVE ORGANS .

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)

inal 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.”

Amazing recovery

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.

Read more about the patient’s story. For more information about Cleveland Clinic’s Transplant Center, visit https://my.clevelandclinic. org/departments/ transplant

Surgical Table Market: Top trends boosting the industry expansion through 2028

According to a recent study from market research firm Graphical Research, the global surgical table market size is set to register a significant growth during the forecast timeframe, due to the rising patient inflow rate across hospitals and clinics. These tables are undergoing technological improvements to enhance the comfort level of both patients and doctors. The prevalence of chronic diseases has significantly increased the number of surgeries carried out every year. The top trends that will impel global industry growth are as follows:

North America (regional valuation will cross USD 580 million by 2028) Demand for powered surgical tables will improve:

North America powered surgical table market size will observe a 3.2% CAGR through 2028 because of the technological advancements NORTH AMERICA POWERED SURGICAL TABLE MARKET SIZE WILL OBSERVE A 3.2% CAGR THROUGH 2028 BECAUSE OF THE TECHNOLOGICAL ADVANCEMENTS INTRODUCED IN THESE PRODUCTS. TECHNOLOGIES, SUCH AS ELECTROHYDRAULIC, ELECTRIC, AND HYDRAULIC POWER SYSTEMS DRIVEN BY BATTERIES ARE BEING INTRODUCED, IMPROVING THEIR DEMAND. introduced in these products. Technologies, such as electro-hydraulic, electric, and hydraulic power systems driven by batteries are being introduced, improving their demand.

For example, U.S.-based healthcare solutions provider Skytron LLC, in 2020, launched its next-gen operating table, the GS70 Salus surgical table. The product provides unique features, such as a powered split-leg with detachable leg sections, back & head to support general surgeries, smart accessories attachment, and visual table lock indicators. These characteristics will enhance the accuracy and comfort of doctors and patients during procedures.

Robust need for operating tables across hospitals & clinics:

The regional hospitals and clinics will exceed USD 376 million in revenue by 2028. Most patients prefer hospitals and clinics to avail post-surgery care and gain access to best-in-

class surgical treatments. North America has a strong presence of highly trained surgeons and well-equipped operation theaters. The incidence of urological, cardiovascular, neurological, and orthopedic conditions is also rising, thereby prompting admissions across hospitals and clinics.

Europe (regional valuation to surpass USD 474 million by 2028) General surgical tables will facilitate ease in carrying out complex surgeries:

Europe general surgical table market share will reach USD 208 million in revenue by 2028. Growing frequency of general surgeries, including appendectomy, cardiovascular surgery, colon procedure, and gynecological & vascular surgeries will aid product uptake. Rise in specialty procedures, such as orthopedic, spinal, and urological surgeries have propelled the demand for advanced operating tables. These tables offer comfort to patients while being laid in a certain position to complete the operation.

Composite surgical tables to gain traction:

The Europe surgical table market size from composite materials will register 4% CAGR through 2028. These tables provide support to patients during operation and help in maintaining an optimum position to ensure that surgeons get proper access during the procedure. Composite materials are lightweight and stronger than meta-based products. The rust-resistance and cost efficiency of fiber and carbon will ensure higher customer preference.

Non-powered surgical tables will be a cost-effective alternative:

Europe non-powered surgical table market will generate over USD 70 million in revenue by 2028 due to the robust growth in patient inflow rate and the rising prevalence of chronic diseases across the region. These tables help surgeons in executing a variety of surgical procedures, such as gynecological and cardiovascular surgeries and are a cost-effective option for healthcare organizations. Manufacturers are investing heavEUROPE GENERAL SURGICAL TABLE MARKET SHARE WILL REACH USD 208 MILLION IN REVENUE BY 2028. GROWING FREQUENCY OF GENERAL SURGERIES, INCLUDING APPENDECTOMY, CARDIOVASCULAR SURGERY, COLON PROCEDURE, AND GYNECOLOGICAL & VASCULAR SURGERIES WILL AID PRODUCT UPTAKE.

CHINA INDUSTRY SIZE WILL CROSS USD 163 MILLION BY 2028 DUE TO THE RISING CASES OF CARDIOVASCULAR AND PERIPHERAL DISEASES. DRASTIC CHANGES IN THE DAILY LIFESTYLE OF THE POPULATION IS ONE OF THE MAJOR FACTORS ADDING TO THE BURDEN OF CHRONIC DISORDERS. ily in their research and development activities to make advanced non-powered tables and improve their performance & efficiency during operations.

Asia Pacific (regional valuation will exceed USD 469 million by 2028) Metal surgical tables will witness robust demand:

APAC market revenue for metal surgical table reached USD 249 million in 2021. Metal tables offer several advantages to patients and surgeons before, during, and after a surgical procedure. For instance, stainless steel is a widely used raw material to manufacture operating tables as it possesses antimicrobial properties. It also has an anti-porous surface which prevents the growth of harmful viruses and pathogens, creating a safer environment for doctors and patients. The growing network of hospitals and clinics will favor the product use.

China surgical table market share will grow:

China industry size will cross USD 163 million by 2028 due to the rising cases of cardiovascular and peripheral diseases. Drastic changes in the daily lifestyle of the population is one of the major factors adding to the burden of chronic disorders. This has notably increased the overall patient hospitalization rates. The high-pressure healthcare ecosystem across Chinese provinces of Shandong and Sichuan will foster the surgical table market outlook through 2028.

Ambulatory surgical centers will increase product adoption:

The ambulatory surgical centers generated more than USD 94 million in revenue in 2021. Patients are preferring to get admitted in these centers because of the wide availability of advanced treatment facilities, medicines, and surgical devices. These centers accommodate several patients at a time and do not compromise on the quality of care offered to them. Governments are also launching various initiatives to support these medical centers and enhance patients’ access to highly skilled healthcare professionals and treatments.