Short-Term Outcomes of Isolated Small Intestine Transplant in Adults: Single center experience over a decade.

Background: Parenteral nutrition (PN) is currently the standard of care for patients with intestinal failure. Intestinal transplantation (ITx) is indicated for patients with life-threatening complications of PN. From registry data the outcomes of ITx have improved significantly compared to the early era. However, registries lack granular, detailed outcome data and include both isolated intestinal and multivisceral transplants. Isolated intestinal transplants differ from multivisceral transplants in terms of indications, patient comorbidities and graft immunopathology. In this study we report current short-term outcomes of isolated adult ITx at our center. Methods: A retrospective review of isolated ITx performed in adults from 2003–2016 was conducted. The peri-operative data examined included: demographics, operative time, cold ischemia time, blood loss, rejection rates, postoperative renal function, readmission rates and 1-year survival. Immunosuppression consisted of induction with thymoglobulin or daclizumab and maintenance with tacrolimus, mycophenolate mofetil, sirolimus and steroids. Results: 87 adult isolated ITx patients were identified (48 M:39 F, median age 45 years, range 18-66). The median cold ischemia time, operative time, and intraoperative blood loss was 7 hours (3.2-12), 7.25 hours (3.4-12.2), and 700 ml (100-3000), respectively. The median post-ITx length of stay was 29 days (12-109). The acute rejection rate within one year was 41% (36/87); only two patients lost the graft due to severe rejection at 6 months and 11 months post-ITx. The majority of patients had postoperative renal dysfunction (56%) with median creatinine peak of 1.8 mg/dl (0.7 - 5.9) at 30 days post-ITx. 79/81 patients (97%) required one or more readmissions (median 5, range 1 - 19) within 1 year of transplant due to dehydration, acute rejection, and sepsis at a median of 5 days’ post ITx (1–250) with a median length of stay of 9 days. The overall 1-year patient and graft survival rates were 88% and 87%. Conclusions: Acute rejection and survival rates of isolated ITx in adults have improved compared to the early era. Strategies to decrease renal dysfunction and readmission rate are needed to further improve outcomes.