Intestinal transplantation in Australia: progress, challenges and future directions

Area of Science:

• Gastroenterology and Hepatology
• Transplantation Surgery
• Pediatric Surgery

Background:

• Intestinal failure necessitates complex management, often leading to life-threatening complications.
• Total parenteral nutrition (TPN) is a temporary measure for intestinal failure, with significant associated risks.
• Intestinal transplantation offers a definitive solution for select patients with intractable intestinal failure.

Purpose of the Study:

• To evaluate the outcomes of intestinal transplantation in Australia.
• To assess patient and graft survival rates post-intestinal transplant.
• To determine the incidence of post-transplant complications and achievement of enteral autonomy.

Main Methods:

• Retrospective cohort study of all adult and pediatric intestinal transplant recipients in Australia.
• Analysis of primary outcomes: patient and graft survival.
• Assessment of secondary outcomes: enteral autonomy and post-transplant complications.

Main Results:

• Nineteen patients (14 adults, 5 children) underwent 20 intestinal transplants between 2010 and 2026.
• One-year graft and patient survival rates were 87% and 93%, respectively; 5-year rates were 67% and 75%.
• All patients achieved enteral autonomy within a median of 21 days; rejection occurred in 40% of patients.

Conclusions:

• The Australian Intestinal Transplant Service achieves excellent patient and graft survival, comparable to international standards.
• Enteral autonomy was successfully achieved in all patients, demonstrating the procedure's efficacy.
• Intestinal transplantation is a safe and effective, life-saving option for appropriately selected patients in Australia.