title: Isolated intestinal transplants vs. liver-intestinal transplants in adult patients in the United States: 22 yr of OPTN data.
abstract: 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 five yr 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 five yr was 80.7%, 57.6%, 42.8%; primary L-ITx was 64.1%, 51%, 44.1% (p = 0.0003 at one, three yr, Wilcoxon test). For retransplants (n = 72), patient and graft survival for isolated ITx (n = 41) at five yr 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 >1.3 mg/dL and pre-transplant hospitalization were negative predictors for outcome of both; bilirubin >1.3 mg/dL was a negative predictor for isolated ITx and donor age >40 yr for L-ITx. Isolated ITx should be considered prior to liver disease for adults with intestinal failure; L-ITx is preferable for retransplantation.
authors.affiliation: University of Arizona, Department of Surgery, Tucson, AZ, USA. cdesai@surgery.arizona.edu
authors.forename: Chirag S
authors.initials: CS
authors.lastname: Desai
authors.forename: Angelika C
authors.initials: AC
authors.lastname: Gruessner
authors.forename: Khalid M
authors.initials: KM
authors.lastname: Khan
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Fishbein
authors.forename: Tun
authors.initials: T
authors.lastname: Jie
authors.forename: Horacio L
authors.initials: HL
authors.lastname: Rodriguez Rilo
authors.forename: Rainer W G
authors.initials: RW
authors.lastname: Gruessner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000401:mortality*; D006085:Graft Survival; D006801:Humans; D007422:Intestines / Q000601:surgery* / Q000637:transplantation*; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D014481:United States; D055815:Young Adult