2011 - ISBTS 2011 Symposium

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Oral Communications 16: Long Term Outcomes

21.326 - Improvement in survival for intestinal transplant patients: Is that due to surgical improvement or improvement of maintenance skill?

Presenter: Hiroshi, Sogawa, New York, United States
Authors: Hiroshi Sogawa1, Thomas Schiano1, Lauren Schwartz1, Kishore Iyer1

Improvement in survival for intestinal transplant patients: Is that due to surgical improvement or improvement of maintenance skill?

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.

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