Undine Gerlach¹, Ulrich-Frank Pape², Olaf Guckelberger¹, Peter Neuhaus¹, Andreas Pascher¹

¹Department of General, Visceral and Transplantation Surgery, Charite-Universitaetsmedizin, Berlin, Germany; ²Department of Medicine, Division of Gastroenterology and Hepatology, Charite-Universitaetsmedizin, Berlin, Germany

Intestinal transplantation (ITX) is a successful treatment for patients with irreversible intestinal failure and associated severe complications. Due to long waiting times and organ shortage, the precise identification of eligible patients and early referral to centres, who perform ITX is important.

We analyzed all patients, who were referred to our centre between 2000 and 2010 concerning referral criteria, waitlist characteristics, and outcome prior to and after transplantation.

87 patients (47 male, 40 female; median age 39.8 ± 13.4 years) were referred to our centre. All patients presented with intestinal failure due to short bowel syndrome (SBS) or motility disorder. Evaluation was initiated for patients with a complicated course of disease under total parenteral nutrition (TPN) following the criteria of the Intestinal Transplant Association. 80.5% of the patients were evaluated for isolated intestinal transplantation (ITX), modified multivisceral (mMVTX) or multivisceral transplantation (MVTX). 56.3% were listed at EUROTRANSPLANT (ET), 33.3% were suffering from severe secondary organ failure, requiring MVTX, 32.2% were transplanted, and 8% died on the waitlist. The arcuated 1-and 5-year survival rates were 72.2% for ITX and 80% for MVTX. According to the current allocation policy in ET, the MELD-score is used for MVTX-candidates, even though it underestimates their mortality risk. With impending lack of vascular access and recurrent sepsis episodes as the main reasons for the high waitlist mortality rather than liver failure, the severity of disease is not mirrored in the MELD-score.

Due to selective donor criteria and organ shortage, the waitlist mortality for patients requiring MVTX is high. Defining the indication for ITX in timely manner is therefore important to prevent secondary organ failure and increasing morbidity. The current allocation policy might have to be reconsidered to prioritize this patient subgroup and give them equitable access to suitable organs in a timely manner.