MGM Healthcare Performs Asia’s First Modified Multi-Visceral Transplant for Inoperable Cancer from the Appendix

• The patient was diagnosed with Pseudomyxoma Peritonei, a rare, devastating, progressive cancer that originated from the appendix
• A modified multi-visceral transplant is a challenging procedure that involves replacement of all the abdominal organs except the liver.

Chennai, February 19, 2025: MGM Healthcare, a leading quaternary care hospital in Chennai, has performed Asia’s first-ever modified multi-visceral transplant (MMVT), a landmark in organ transplantation and oncological treatment, for a patient suffering from inoperable Pseudomyxoma Peritonei (PMP) arising from the appendix. The patient is recovering well under close supervision, highlighting the success of this pioneering procedure.

PMP is a rare, complex, and progressive cancer originating in the appendix, spreading throughout the abdominal cavity, and causing extensive mucinous deposits. Its aggressive nature often makes curative treatment challenging, with many cases deemed inoperable by conventional surgery.

A MMVT is a specialised procedure involving the transplantation of multiple abdominal organs en-bloc. However, unlike a conventional multi-visceral transplant that replaces the stomach, pancreas, duodenum, small intestine, and liver, the modified approach enables exclusion of the liver based on disease extent.

The exclusion of the liver makes the MMVT a more challenging surgical procedure because of the need to preserve the blood supply to the native liver while removing all the other diseased organs adjacent to it.

This case represents a 58-year-old lady with PMP arising from the appendix. She had failed previous attempts of cytoreductive surgery (CRS) and Heated Intraperitoneal Chemotherapy (HIPIC) as well as systemic chemotherapy. She presented with obstruction and perforation of the intestine from the tumor that had a fungating mass on her abdominal wall. She had intestinal failure, abdominal wall failure and poor nutrition. The extent of tumor spread had rendered more attempts at conventional surgery unfeasible.

The multidisciplinary team at MGM Healthcare, developed a groundbreaking treatment plan—Asia’s first MMVT. This complex procedure involved the removal and transplantation of multiple abdominal organs, offering the patient a renewed chance at life.

The surgery was led by Professor Dr. Anil Vaidya, a globally renowned transplant surgeon. He pioneered the use of MMVT for PMP at Oxford University Hospitals, UK and later at The Cleveland Clinic, USA.  His team is now leading the efforts at MGM Healthcare, Chennai to develop this new treatment option in India.

Dr. Senthil Muthuraman of MGM Healthcare co-led the transplant alongside oncosurgeon Dr. Sivakumar Mahalingam. It is crucial to have the involvement of both Oncosurgery, and Transplant teams to ensure that the cancer removal and transplant process is efficiently executed.

Dr. Dinesh Babu and Dr. Nivash Chandrasekaran’s Anesthesia and Intensive care team were involved in building up the patient’s nutrition and exercise tolerance before the operation, which, are the crucial cornerstones in the success of the procedure. Their meticulous attention to details such as central line care and optimal calorie requirement ensured a predictable outcome during and after surgery.

Professor Dr. Ramakrishna, an internationally renowned oncosurgeon who referred the patient, played a key role in the multidisciplinary discussions that led up to the transplant. Pleased with the outcome, Professor Ramakrishna emphasised that careful selection of patients is the key for continued success in this new treatment option.

In his comments, Prof. Vaidya further added, “This is a defining moment. With limited treatment options for advanced PMP, this modified multi-visceral transplant offers a revolutionary alternative, bringing hope to patients who previously had no curative options. Our recent publication in the Annals of Surgery demonstrated significant 5-year survival rates for such patients who otherwise faced imminent death.”

Furthermore, he opined that “for inoperable PMP cases with extensive cancer spread, this approach enables the complete removal of diseased organs while preserving functional ones. It is crucial for restoring digestive and metabolic function when standard surgical resections are not viable. The procedure demands a precise balance of minimal immunosuppression—to prevent cancer recurrence—while ensuring the transplanted organs remain protected from immune rejection”.

The patient is currently recovering under close supervision, with post-transplant care being carefully managed by a dedicated home care team. Early recovery indications are promising, marking a significant success for this novel procedure.

Prof. Vaidya added that “the ability to include MMVT as a ground breaking treatment option for patients in India has been possible only because of the generosity of brain-dead organ donors and the continued untiring support of the government initiatives that promote organ donation” He remains indebted to the member secretary of TRANSTAN, Dr. N. Gopalakrishnan for his close collaboration and support to the program.

MGM Healthcare remains a leader in medical innovation, consistently advancing transplant medicine through its progressive initiatives. This collaboration brings together a distinguished team of specialized surgeons, physicians, anesthetists, intensivists, interventional radiologists, and allied care professionals to offer state-of-the-art transplant services.

This latest milestone underscores MGM Healthcare’s commitment to pushing the boundaries of surgical excellence. By successfully performing this complex procedure, MGM Healthcare has positioned India on the global stage for pioneering medical advancements.