Raffaele Girlanda, Erin Fennelly, Stephanie Kozlowski, Eddie Island, Cal Matsumoto, Thomas Fishbein

Georgetown Transplant Institute, Washington, DC, United States

Background/Aim: Adult intestinal transplant recipients often receive a graft from a small donor due to the loss of abdominal domain secondary to previous surgeries. There is no data on the relationship between length of the intestinal graft and allograft function. TPN independence post-transplant has been considered a surrogate marker for successful intestinal transplant. We aimed at determining the impact of length of the intestine graft on TPN independence post-transplant.

Patients and Methods: 46 adult intestinal transplant recipients (25 M, 21F, median age 44 y, range 18-66) who underwent ITx between 2003 and 2011 were included. Grafts were 37 isolated intestine, 1 liver-intestine and 8 multivisceral. The following parameters were analysed from a prospectively collected database: donor age, weight, donor/recipient age ratio and weight ratio, length of Intestine (cm), downtime and cardio-pulmonary resuscitation before organ procurement, cold ischemia time and duration of TPN post-transplant.

Results: The median length of intestinal graft was 309 cm (range 148-510) and the median duration of TPN post-transplant was 15 days (range 3-364). Overall there was no correlation between the duration of TPN and length of the graft (Kendall’s rank test p=0.92), donor/recipient age (p=0.22) and weight (p=0.59) ratio, cold ischemia time (p=0.94), donor CPR (p=0.26) and type of graft (p=0.12). There was no significant difference in the median length of the graft (300 cm vs. 310, p=0.5) between seven patients (15%) with prolonged ICU stay post-transplant who required TPN for >3 months and 39 patients who received TPN for a median of 14 days (3-55). Likewise, the duration of TPN post-transplant was not significantly different in recipients of grafts <300 cm vs. >300cm (13.5 vs. 14 days, p=0.7) and there was no correlation between TPN duration and length of the graft within these two groups (p=0.35 and 0.9, respectively).

Conclusion: The length of intestinal grafts does not impact on TPN duration post-transplant. Intestinal grafts from small donors can be successfully transplanted in adult recipients. Further studies are required to determine the impact of additional factors (re-operations, rejection episodes) on TPN duration post-transplant.