Outcomes after intestinal transplantation in the UK

Claire J Counter¹, Sally N Rushton¹, Darius Mirza², Khalid Sharif³, Girish Gupte³, Andrew Butler⁴, Steve Middleton⁴, Peter Friend⁵, Simon Travis⁵, Hector Vilca-Melendez⁶, Jonathan Hind⁶

¹NHS Blood and Transplant, Bristol, United Kingdom; ²Queen Elizabeth Hospital , Birmingham, United Kingdom; ³Birmingham Children's Hospital, Birmingham, United Kingdom; ⁴Addenbrooke's Hospital, Cambridge, United Kingdom; ⁵Oxford Transplant Centre, Oxford, United Kingdom; ⁶King's College Hospital, London, United Kingdom

Background: The first intestinal transplants in the UK took place in the early 1990s.  Transplant activity has increased since the allocation of donor organs was altered to favour patients waiting for intestinal transplantation.

Methods: Data on 179 transplants between 1 July 1991 and 31 December 2012, recorded by Organ Donation and Transplantation were analysed.  Trends in patient demographics and types of transplant were investigated and the Kaplan-Meier method was used to estimate patient survival post transplant.

Results: Over the whole time period, the most common indications for transplant were gastroschisis and cholestatic liver disease for paediatric patients (aged <16 years) and primary vascular disease and Crohn's disease for adult patients.  Of 179 transplants, 120 (67%) were paediatric and 59 (33%) were adult patients.  The proportion of paediatric and adult transplants has changed over the time period.  Between 1999 and 2005 only paediatric transplants were performed, but recently the number of adult transplants has increased; of 36 transplants in 2011 and 2012, 22 (61%) were adult patients.

Of the 179 transplants performed, 57 (32%) were liver, bowel and pancreas, 56 (31%) were bowel only transplants and the remaining were either multivisceral, liver only or modified multivisceral.  The type of transplants performed has changed recently with more transplants being performed without the liver.  Prior to 2009, 77% of transplants included the liver compared with 35% between 2009 and 2012 inclusive.

Paediatric and adult patient survival following intestinal transplantation has improved at one year post transplant to 84% and 78%, respectively, for transplants between 2008 and 2012.  Five year patient survival was 60% and 67% for paediatric and adult patients, respectively, transplanted between 1998 and 2012.

Conclusion: Over the last decade, intestinal transplant activity in the UK has increased, with recent changes in the types of transplants performed and an improvement in outcomes.