Isolated intestinal transplants vs. liver-intestinal transplants in adult patients in the united states: 22yr of optn data

We examined the outcomes of adult intestinal transplants (ITx); isolated ITx vs. liver-intestinal transplants (L-ITx) were compared using the UNOS database (1987-2009). Of 759 ITx transplants in 687 patients, 463 (61%) were isolated and 296 (39%) were L-ITx. Patient survival for primary isolated ITx at one, three, and fiveyr was 84%, 66.7%, and 54.2%; and primary L-ITx was, 67%, 53.3%, and 46% (p=0.0005). Primary isolated ITx graft survival at one, three, and fiveyr was 80.7%, 57.6%, 42.8%; primary L-ITx was 64.1%, 51%, 44.1% (p=0.0003 at one, threeyr, Wilcoxon test). For retransplants (n=72), patient and graft survival for isolated ITx (n=41) at fiveyr was 40% in era 1 (1987-2000) and 16% in era 2 (p=0.47); for retransplanted L-ITx (n=31), it improved from 14% to 64% in era 2 (p=0.01). Cox regression: creatinine >1.3mg/dL and pre-transplant hospitalization were negative predictors for outcome of both; bilirubin >1.3mg/dL was a negative predictor for isolated ITx and donor age >40yr for L-ITx. Isolated ITx should be considered prior to liver disease for adults with intestinal failure; L-ITx is preferable for retransplantation.