Introduction: Intestinal (IT) and multivisceral (MVT) transplants are surgeries after which is not unusual to require multiple readmissions.

Methods: Eleven intestinal transplants were performed in adults at Duke University Hospital during a 5year period and were followed until December 31,2016. Three were IT; the rest were MVT (small bowel, liver and pancreas).
Six patients went into transplant on parenteral nutrition (PN) for short gut syndrome (SGS). One of them had desmoid tumors and served as a domino liver donor. The rest had cirrhosis and extensive portomesenteric thrombosis.
Nine patients got induction with antithymocyte globulin (ATG); two with basiliximab.

Results: All of the patients were discharged except for one who expired 31 days after transplant.
The mean length of stay (LOS) was 40.4 days - 24.3 days for IT and 47.2 days for MVT.
Thirty percent of the patients were discharged on PN and 60% on tube feeds.
A LOS of 45 days or longer was associated with need of PN at discharge (p 0.011)
Eight patients had acute cellular rejection (ACR). Two of them (IT) were severe; the rest were mild/moderate.
The first readmission was within the first month of discharge in all patients except for one.
The number of readmissions per patient was between 4 and 43 (total 131; mean 13.1; median 10.5). The LOS was between 1 and 69 days (mean 7.6 days).
The total number of admissions within a year of transplant was 80 for all patients. Average LOS 58 days.
The readmissions were: non-elective (111), elective (20), non serious (103), serious (28) (bacteremia, CMV viremia /enteritis, severe ACR, non-elective intra-abdominal surgery and abscesses, PRES, death). Admissions were also categorized per cause (table 2)
Three patients died; two had IT. Causes of death were: aortic bleed from mycotic aneurysm; disseminated aspergillosis; severe ACR,MAC infection. Time between transplant and death was 31, 162, 471 days respectively.

Conclusions: The majority of readmissions were in the first year after transplant. The majority were non-elective and non-life-threatening. Most common causes were infections and gastrointestinal symptoms.Beyond the first year of transplant, the number of readmissions and LOS of each one declined, with most patients either not having any or a single brief hospitalization.
In comparison with the standard of care alternative therapy being PN, long term complications and need for hospitalization beyond the first year are similar.