Introduction: Since 2008, intestinal transplantation (ITx) has grown significantly in the UK with the development of 2 adult centres. In Oxford, patients have undergone small bowel, modified multivisceral transplants, concurrent kidney transplants but not liver-containing grafts. We have also undertaken abdominal wall^[1][2] or sentinel skin flaps. We have undertaken an analysis of all our patient outcomes following ITx.

Methods: This is a retrospective view of outcomes for all transplanted patients, using data prospectively collected in a database.

Results: 36 transplants were carried out in 35 individuals; 1 case was a retransplant. Mean age was 41.9years (range 23- 73). M/F: 22:14. Median follow up was 774 days (range 16- 3029). Indications for transplantation included Crohn’s disease (7/36, 19%), intra-abdominal desmoids (4/36, 11%), visceral neuromyopathy (5/36, 14%), vascular ischaemia (6/36, 17%), radiation enteritis (2/36, 6%), neuroendocrine tumour (1/34, 3%), pseudomyxoma peritonii (6/36, 17%) and other (5/36, 13%).  Protocol immunosuppression included alemtuzumab induction followed by tacrolimus monotherapy. Overall survival was 24/36 (67%): isolated small bowel 1y=87%, 5y=64%; MMV 1y=79%, 5y=55%. Deaths occured at median (range) 6.8mo (0.5-66.7) post-ITx, aged 46y (26-73); 7/12 (58%) were female. Causes of death included infection/sepsis, rejection, GVH. Complications for all cases included PTLD in 4/34 (12%), GVH in 3/33 (9%), acute rejection in 8/34 (24%) intestinal grafts and 7/20 (35%) vascular composite allografts, haemolytic anaemia in 4/34 (12%) and chronic rejection in 3/34 (9%). 3 cases of chronic rejection, all of whom were explanted; 1 case of acute rejection requiring explantation. 1 patient had a successful pregnancy, and delivered a healthy girl at 33 weeks gestation is  currently aged 2 years and well^[3]. 9/20 patients (45%) are in employment and 1/20 (5%) requires home intravenous fluids.

Conclusion: Increasing intestinal transplant activity has included new indications, and novel approaches to abdominal wall closure and graft monitoring, with results that have improved over time. Survival is improving and getting closer to long term survival for those with IF on HPN^[4].

[1] Gerlach UA et al, Abdominal wall transplantation: skin as a sentinel marker for rejection. Am J Transplantation. 2016; 16:1892-900
[2] Giele H et al. Remote revascularisation of abdominal wall transplants using the forearm. Am J Transplantation. 2014; 14: 1410-6
[3] Blackwell V et al. Multidisciplinary care ensures successful pregnancy following intestinal transplantation: a case report. British Journal of Obstetrics and Gynaecology. 2016; epub doi: 10.1111/1471-0528.14420
[4] Dibb M et al. Survival and nutritional dependence on home parenteral nutrition: Three decades of experience from a single referral centre. Clinical Nutrition. 2016; epub doi: 10.1016/j.clnu.2016.01.028