Developing trends in the intestinal transplant waitlist

Area of Science:

• Transplantation research
• Organ donation and transplantation statistics
• Pediatric surgery

Background:

• The United Network for Organ Sharing (UNOS) database tracks organ transplant waitlists.
• Intestinal transplantation (ITx) includes isolated ITx and combined liver-intestine transplants (L-ITx).
• Understanding waitlist trends is crucial for resource allocation and patient management.

Purpose of the Study:

• To analyze trends in the ITx waitlist from 1993 to 2012.
• To differentiate trends between isolated ITx and L-ITx.
• To identify factors influencing waitlist dynamics, particularly in pediatric populations.

Main Methods:

• Retrospective analysis of the UNOS database from 1993 to 2012.
• Categorization of waitlist registrants into isolated ITx and L-ITx.
• Spline modeling to identify significant trend changes in waitlist registration.

Main Results:

• Waitlist registrants peaked in 2006, with a significant trend change (p < 0.001).
• L-ITx constituted the largest proportion of new registrants, showing a highly significant trend change in 2006 (p < 0.001).
• Waitlist mortality peaked around 2002, highest for L-ITx in infants and adults, though pediatric deaths have decreased.

Conclusions:

• The ITx waitlist experienced a significant trend shift in 2006, primarily driven by L-ITx, especially in infants.
• Improved management of intestinal failure in infants has led to decreased referrals for L-ITx.
• While waitlist mortality has seen some improvements, particularly in pediatric L-ITx, continued monitoring is essential.