Predicting Post-intestinal Transplant Patient Survival Based on A Priori Data

Intestinal transplantation (ITx) is the definitive treatment for patients with intestinal failure who experience severe complications on total parenteral nutrition. However, ITx has the highest morbidity among solid organ transplants. Currently, there is little information to guide clinicians in choosing the timepoint at which the advantages of ITx outweigh the risks. We seek to predict post-ITx survival using a priori data to help patients determine whether to undergo ITx.

This study used data from the Organ Procurement and Transplantation Network database on all ITx procedure performed in the United States from 2016 to 2021 (n = 567), of whom 17.3% (n = 98) were censored as lost to follow-up and 33.3% (n = 189) died. The cohort included both pediatric and adult patients as well as multiorgan patients. The inclusion of such a diverse cohort was supported by sensitivity analyses. An adjusted Cox model was used to model 2-y posttransplant patient survival using data available before transplant.

Repeat sepsis on total parenteral nutrition before transplant (hazard ratio [HR], 1.46; 95% confidence interval [CI], 1.07-1.97), older age (HR, 1.02; 95% CI, 1.02-1.03), and the need for a concomitant liver (HR, 1.43; 95% CI, 1.03-1.99) were associated with poorer posttransplant survival. Lower bilirubin levels were associated with higher posttransplant survival.

This research reinforces the conclusion that an ITx should be pursued before liver disease progresses to the point of requiring a concomitant liver.