Ichkhanian Y, Beltran N, Nagai S, and Jafri S. Role of surveillance biopsy frequency post intestine transplant: A tertiary care experience. Transplantation 2021; 105(7 SUPPL 1):S14.
Background: With only 81 intestine transplant (IT) in the U.S. in 2019, the literature on this type of solid organ transplant remains scarce. Frequent surveillance biopsy is required on the first month post IT due to high-risk of acute rejection, however, the frequency of surveillance biopsy 1-month post IT is often determined by the physician and the institutions' preference.
Aims: Report IT outcomes and clinical impact of surveillance biopsy at a single tertiary care center.
Methods: This is a retrospective review of patients that underwent IT during the time-period between 08/2010 and 03/2020. Primary outcome was the correlation between increased protocol biopsies and mortality. Secondary outcomes included correlation between increased protocol biopsies and hospital re-admissions, length of hospital stay, and rate of biopsy proven rejection detection. Kaplan-Meier curves was used to perform the survival analysis at 6-month, 1-year, and 2-years post-transplant.
Results: A total of 35 patients (mean age 47.6 ± 12.9 years, F 22 (63%) underwent IT for: ischemic bowel 11 (31%), Chron's disease 9 (25%), neuroendocrine tumor 6 (17%), trauma 3 (9%) and 'others' 6 (17%), of which 14 (40%) were part of multivisceral organ transplant. During the first-year posttransplant, the median number of biopsies was 12 (IQR 6-30), with evidence of definite acute graft rejection in 40%, 27%, and 41% at the 1-3, 3-6, and 6-12 post IT time intervals, respectively. During the duration of the study, the mortality rate was 18/35 (51%) at a median time of 37 (12-60) months post IT, and a total of 8/35 (23%) patients underwent enterectomy at a median time of 12 (8-36) months post IT (Table 1). In general, there was survival benefit for patients who had a total number of biopsies of ≥ 10 as compared to < 10 biopsies at the time interval of 6-months post IT, (p=0.008) (Table 2). There was a non-significant trend with longer median length of hospital stay in patients with greater number of biopsies.
Conclusion: Our results indicate evidence of survival benefit of increased protocol biopsies. Studies with larger sample sizes are required to validate our results.
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