Douglas Farmer¹, Robert S. Venick², Laura Wozniak², Yvonne Esmailian¹, Hasan Yersiz¹, Kanela Artavia⁵, Laurie Reyen⁴, Susan Ponthieux¹, Erin Core¹, Villy Hwang¹, Anna Zafar¹, Galen Cortina³, Sue V. McDiarmid², Ronald W. Busuttil¹

¹Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; ²Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; ³Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; ⁴Department of Nursing, UCLA Health System, Los Angeles, CA, United States; ⁵Department of Comfort Care, UCLA Health System, Los Angeles, CA, United States

Introduction: Advances in ITx have led to improvements in outcome. Still, long-term survival lags behind other solid organ transplants. The aim of this study was to identify factors leading to better outcome in an effort to further advance survival.

Methods: A retrospective analysis of a prospective database was undertaken. A battery of preoperative and postoperative variables was analyzed. Study end-points were patient death and graft loss. Standard statistical analysis was undertaken. The median followup was 31mo.

Results: From Nov 1991 to May 2011, 97 pt underwent 115 ITx. The majority were male, Latino children with surgical SGS as the etiology of intestinal failure. At ITx, 55% were admitted from home with a mean M/PELD score 15 ± 11. ITx type was: isolated intestine (24%), liver-intestine (61%), multivisceral (11%), and modified multivisceral (4%). 23% required recipient splenectomy and 27% had donor spleens removed after reperfusion. The majority received IL2RA induction immunotherapy. Major complications included: acute rejection (57%), chronic rejection (7%), GVHD (3%), CMV disease (5%), PTLD (8%), and infectious enteritis (61%). The overall 5-yr patient and graft survival are 62% and 52%.

Multivariate analysis of factors impacting outcome reveal that the presence of donor specific antibody and the requirement for recipient splenectomy were associated with worse patient survival (p<0.05) while the presence of donor specific antibody and the use of a non-liver inclusive ITx type were associated with worse graft survival (p<0.01).

Conclusion: This large, single center experience with ITx reveals quite good overall outcomes with relatively low rates of major complications. Still, outcomes need improvement. Statistical analysis revealed several important variables which can be measured prior to ITx that impacted outcome. Adapting strategies to manipulate these variables may further improve outcomes after ITx.