OPTN/SRTR 2022 Annual Data Report: Intestine.

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.