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OPTN/SRTR 2022 Annual Data Report: Intestine
Simon P Horslen1, Yoon Son Ahn2, Nicholas L Wood2
1Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN; Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.
Insights
Intestine transplants are declining, especially for children, with adult waiting list candidates increasing. Adult transplant rates have fallen, particularly for combined intestine-liver cases, while pediatric survival remains better.
Area of Science:
- Transplantation Medicine
- Gastroenterology
- Pediatric Surgery
Background:
- Intestine transplantation is a life-saving procedure for irreversible intestinal failure, yet it remains the least frequently performed solid organ transplant.
- A concerning trend of decreasing intestine transplant listings and procedures has been observed over the past 15 years, disproportionately affecting pediatric populations.
Purpose of the Study:
- To analyze recent trends in intestine transplantation, including waiting list dynamics, transplant rates, and outcomes.
- To identify factors contributing to the decline in adult intestine transplants and compare outcomes between pediatric and adult recipients.
Main Methods:
- Retrospective analysis of national intestine transplant data from 2022.
- Examination of waiting list demographics, transplant rates, pretransplant mortality, and graft/patient survival.
- Comparison of outcomes for isolated intestine transplants versus combined intestine-liver transplants.
Main Results:
- Intestine transplant numbers decreased to 82 in 2022, with adult candidates comprising 61% of the waiting list.
- Adult transplant rates declined to 55.6 per 100 patient-years, driven by fewer combined intestine-liver transplants.
- Pediatric transplant rates remained stable at 22.8 per 100 patient-years; pediatric recipients showed better graft and patient survival.
- Graft failure rates improved for isolated intestine transplants but not for combined procedures.
- Posttransplant lymphoproliferative disorder rates were higher in recipients of intestine-only transplants.
Conclusions:
- The declining trend in intestine transplantation, particularly for pediatric patients, requires urgent attention.
- Combined intestine-liver transplant candidates face higher pretransplant mortality, highlighting the complexity of these procedures.
- While outcomes for isolated intestine transplants show improvement, overall graft and patient survival are better in pediatric recipients.
Abstract:
Intestine remains the least frequently transplanted solid organ, although the survival and quality-of-life benefits of transplant to individuals with irreversible intestinal failure have been well demonstrated. The trend seen over the past 15 years of fewer listings and fewer transplants appears to be continuing, most noticeably in infants, children, and adolescents. There were only 146 additions to the intestine waiting list in 2022, and the proportion of adult candidates continues to increase, so that now 61% of the intestine waiting list are adult candidates. There has been little change in the distribution by sex, race and ethnicity, or primary diagnosis on the waiting list, or for those receiving transplant. The transplant rate for adults has decreased to 55.6 transplants per 100 patient-years, but the pediatric transplant rate remains relatively stable at 22.8 transplants per 100 patient-years. The decrease in transplant rates for adults is primarily the result of falling rates for those listed for combined intestine-liver, and this is reflected in the pretransplant mortality rates, which are twice as high for candidates in need of both organs compared with those listed for intestine alone. Overall, intestine transplant numbers decreased to a total of 82 intestine transplants in 2022, only one above the lowest ever value of 81 in 2019. No major changes were seen in the immunosuppression protocols, with most recipients having induction therapy and tacrolimus-based maintenance. Graft failure rates appear to have improved at 1, 3, and 5 years for intestine without liver, but this is not seen for combined intestine-liver. Graft and patient survival are better for pediatric recipients compared with adult recipients for both liver-inclusive and liver-exclusive transplant. Rates of posttransplant lymphoproliferative disorder are higher for recipients of intestine without liver.
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