OPTN/SRTR 2023 Annual Data Report: Intestine

Area of Science:

• Gastroenterology and Hepatology
• Transplantation Medicine
• Surgical Oncology

Background:

• Intestine transplantation is a vital treatment for intestinal failure, often resulting from long-term parenteral nutrition complications or abdominal catastrophes.
• Despite its critical role, intestine transplantation is infrequently performed, highlighting the need for continued research and improved outcomes.
• The demand for intestine transplants, particularly in the adult population, has been steadily increasing over recent years.

Purpose of the Study:

• To analyze the trends, outcomes, and complications of intestine transplantation in 2023.
• To compare graft survival rates and patient mortality between intestine-without-liver and intestine-with-liver transplants.
• To assess the incidence of acute rejection and post-transplant lymphoproliferative disorder (PTLD) in different transplant scenarios.

Main Methods:

• Retrospective analysis of intestine transplant data from 2023, including waiting list additions, performed procedures, and patient demographics.
• Evaluation of graft survival rates at 1 and 5 years for adult and pediatric recipients, stratified by transplant type (with or without liver).
• Analysis of mortality on the waiting list and incidence of acute rejection and PTLD.

Main Results:

• In 2023, 135 candidates were added to the waiting list, and 95 intestine transplants were performed, with 33 in pediatric recipients.
• Graft survival varied: intestine-without-liver showed 1-year survival of 78.3% (adults) and 76.1% (pediatrics), while intestine-with-liver showed 57.8% (adults) and 81.1% (pediatrics).
• Acute rejection occurred in ~20% of patients within the first year. 5-year PTLD incidence was higher in intestine-without-liver (11.5%) vs. intestine-with-liver (2.5%) recipients.

Conclusions:

• Intestine transplantation remains a critical therapy, but outcomes differ significantly based on whether a liver is included.
• While waiting list mortality is low for intestine-without-liver transplants, it exceeds 10% for those awaiting intestine-with-liver transplants.
• Long-term graft survival and complication rates necessitate ongoing research, especially considering advances in intestinal rehabilitation and the growing adult recipient pool.