OPTN/SRTR 2023 Annual Data Report: Intestine

Abstract

Intestine transplant can have significant health and quality-of-life benefits for those who require it. Despite its infrequent use, intestine transplant remains a mainstay of treating those with complications from long-term parenteral nutrition due to intestinal failure, as well as salvage therapy for those with a significant abdominal catastrophe. In 2023, there were 135 candidates added to the intestine transplant waiting list. Those awaiting intestine-without-liver transplant have low mortality on the waiting list, with no reported deaths in 2023. However, 8 patients died awaiting intestine-with-liver transplant, and the estimated 3-year mortality for those listed exceeds 10.0%. A total of 95 intestine transplants were performed in 2023, with only 33 performed in the pediatric age range. However, 18 of 34 recipients of intestine-with-liver transplant were in the pediatric age range. Immunosuppression for intestine transplants most commonly included an induction agent followed by maintenance with a combination of medications that included tacrolimus. In the recipients of intestine-without-liver transplants, 1- and 5-year graft survival were 78.3% and 46.5% in adult and 76.1% and 52.2% in pediatric recipients, respectively. In the recipients of intestine-with-liver transplants, 1- and 5-year graft survival were 57.8% and 45.6% in adult and 81.1% and 60.0% in pediatric recipients, respectively. Acute rejection episodes occurred for approximately 20.0% of patients within the first year. The 5-year cumulative incidence of posttransplant lymphoproliferative disorder was higher in those with an intestine-without-liver transplant (11.5%) compared with those who also received a liver (2.5%). Rates of intestine transplant have remained stable for the past several years, with increasing need in the adult population. Future reports may reflect whether children who have avoided intestine transplant with the recent advances in intestinal rehabilitation ultimately require the procedure in adulthood.