Hiroshi Sogawa, Thomas Schiano, Lauren Schwartz, Kishore Iyer

Intestinal Transplant Program, Mount Sinai School of Medicine, New York, NY, United States

Background: Although 1-year survival rate following intestinal transplantation (ITx) over the last 20 years has steadily improved, long-term survival remains sub-optimal. We analyzed survival with and without initial 12-month mortality in ITx from the UNOS database to determine temporal course of survival improvements.

Methods: Patients who had ITx between 1/1990 and 9/2010 were analyzed from the UNOS database. All patients were divided into three groups by their transplant year (Group 1: ITx between 1990-1996, Group 2: ITx between 1997-2003, Group 3: ITx between 2004-2010). Patient and graft survival was analyzed using Kaplan-Meier method (Log rank). After this, all deaths in the first 12 months of each group were removed. Patient and allograft survival was then once again compared across the 3 groups.

Results: Of 1988 patients transplanted, 187 were in Group1, 629 in Group 2, and 1157 in Group 3.There was significant improvement in patient (Figure 1) and graft survival across the 20-year period (P < 0.000). A similar comparison with deaths in the first year removed was made. Patient survival in Group 2 & 3 improved beyond 1-year (Figure 2) and suggests that initial surgical management and longer-term maintenance treatment contributed to improved patient survival. In contrast, comparison of survival in Group 2 and 3 revealed that patient survival improved in the last 13 years but the improvement was mainly in the first year, likely due to improvement of initial surgical management and early post-operative care.

Conclusions: These data suggest that initial surgical management following ITx has been steadily improving but improvements in longer-term maintenance of post ITx patients has hit a plateau. In order to improve long-term outcomes in intestinal transplantation, we need to develop new strategies to improve maintenance treatment such as strategies to prevent chronic rejection, immune tolerance induction, or prevention of PTLD.