142: Intestinal Transplantation: The Australian Experience

Introduction: A joint adult and pediatric intestinal transplant (ITx) program for Australia was developed in 2010 to provide ITx to patients with irreversible intestinal failure (IF) who have developed life-threatening complications of parenteral nutrition. We analyzed the outcomes of patients transplanted in Australia since its inception. Methods: This is a retrospective observational study of all patients who underwent ITx at our center between 2010-2022. Patient demographics, clinical characteristics, nutrition support, and transplant outcomes were evaluated. Results: Twelve patients have received an intestinal graft (n=7 adults, median age 32.9 (IQR 29.7, 45.7) years; n=5 pediatrics, median age 10.6 (9.9, 13.3) years); two-thirds of all recipients were male. Intestinal failure was caused by short-gut syndrome in the majority of patients (58%), with dysmotility (17%), desmoid tumours (17%) and portomesenteric thrombosis (8%) accounting for the remaining transplants. Recipients waited a median 530.5 (179, 656) days for transplant, of which 7 (58%) were combined liver-intestine transplants, 2 (17%) isolated intestine, and 3 (25%) multivisceral (n=2 full multivisceral, n=1 modified multivisceral). Two patients (17%) also received simultaneous kidney transplant. Patients spent 10.5 (6, 16.5) days in ICU after transplant, with median hospital length of stay 41 (35, 61.5) days. LOS was not significantly different in adult versus pediatric cohorts (p>0.05). At a median follow up of 1152 (352, 2793) days, graft and patient survival was 75% (n=9) and 83% (n=10), respectively. Two deaths occurred in adult patients due to opportunistic infections. Enteral autonomy was reached in 92% of patients, at median 22 (17, 28.5) days after transplant. Six patients (50%) had a total of 7 episodes of rejection. Of these, 2 were graded severe; 1 resulted in graft loss at 167 days post-transplant, whilst the other was rescued with infliximab. Median onset of rejection was 2 months post-transplant (range 13 days – 11 months). Standard immunosuppression was basiliximab induction followed by maintenance tacrolimus and mycophenolate. There was 1 episode of GVHD (8%), which was managed with immunosuppression minimization. Conclusions: The first 12 years of ITx in Australia has demonstrated transplantation to be a viable and life-saving option for patients with irreversible IF in our region. Despite small case numbers, outcomes are consistent with the international experience. Enhanced awareness of ITx in Australia may increase patient referrals, transplant activity and ultimately improved outcomes for patients with irreversible IF.