Single-center experience of over 300 adult and pediatric intestinal transplants

The results of intestinal transplantation (ITx) have improved over the last decade. Adult and pediatric ITx was first initiated at our center in November 2003. We retrospectively reviewed our experience with ITx. Primary immunosuppression consisted of IL-2 receptor blockade induction with maintenance steroids, Tacrolimus, and Sirolimus. Sensitized recipients or recipients with a positive cytotoxic crossmatch received Thymoglobulin induction. 337 ITx have been performed in 324 patients from November 2003 to December 2022. 21 were retransplants, 8 were retransplants with the primary transplant at another center. Overall average age is 23.8 ± 21.4 years. 161 (47.7%) pediatric (<18 yrs), average age 3.53 ± 3.91 yrs (range 3 months – 17 yrs) and 176(52.3%) adult, average age 42.3 ± 11.9 yrs (range 18 – 66 yrs). Grafts comprised of 204 isolated intestines (iITx), 80 liver-intestine (LI), 45 multivisceral (MVTx), and 8 modified multivisceral (mMVTx) transplants. 218 recipients received an en-bloc colon graft and 13 received a concomitant kidney graft. Most common indication in pediatric recipients were Gastroschisis, NEC, pseudoobstruction/motility, and volvulus. Adult indications were Pseudoobstruction/Motility, Mesenteric ischemia, and Inflammatory Bowel Disease. Overall, 1- and 3-year patient survival are 84.4 % and 71.4 % respectively. 1-year isolated ITx, Liver-Intestine, modified MVTx and MVTx patient survival were 88.1%, 90.0%, 75.0% and 60.0%. Overall pediatric 1 year patient survival was 88.1% and adult 1 year patient survival was 80.9% (p=0.09). Overall, 1 year freedom from rejection (FFR) was 70.8%. FFR in adult and pediatric recipients was 57.6% and 84.4% respectively (p < 0.0001). Liver inclusive grafts had a higher 1-year FFR at 83.1 % vs 64.1% (p =0.0004). Dividing up our center experience volume in exactly half, the 1-year patient survival in the first half (n= 168 cases) was 82.9% and the second half (n= 169 cases) 87.2% (p= 0.17). This data reflects a cumulative experience of ITx at a large single institution with an extensive pediatric and adult ITx experience. 1 year patient survival has shown a tendency for improved results in the latter half of our experience.