Outcomes Following Graft Enterectomy After Intestinal and Multivisceral Transplantation: A Multicenter Analysis

Document Type

Conference Proceeding

Publication Date

8-1-2025

Publication Title

Am J Transplant

Abstract

Purpose: Graft enterectomy following intestinal transplantation (IT) or multivisceral transplantation (MVT) is a critical event that significantly impacts patient morbidity, survival, and long-term nutritional dependence. Data on IT failure requiring enterectomy and outcomes following enterectomy remain poorly defined. This study aims to describe the clinical outcomes of patients who underwent enterectomy after IT or MVT, providing insights into the post-enterectomy course. Methods: Retrospective analysis of 20 patients who underwent IT or MVT and subsequently required graft enterectomy from four transplant centers between 2012 and 2024. The primary outcome was patient survival analyzed by Kaplan-Meijer analysis. Secondary outcomes included retransplantation and infection within 3 months. Results: Among the 20 patients who underwent graft enterectomy following IT or MVT, there were 10 men and 10 women, with 55% receiving their transplants before the age of 18. The average age of the cohort at the time of enterectomy was 21 years, with a median age of 7 years. The average age of the pediatric patients was 4, and adult patients was 45. IT alone accounted for 75% of transplants, while 25% were MVT. Rejection was the primary indication for enterectomy in 100% of cases. MVT recipients were significantly more likely to undergo re-transplantation compared to IT recipients (p=0.01) and showed a trend toward improved survival (p=0.40). At 6 months and 1-year post-enterectomy, survival rates were 73% and 67% for IT recipients and 80% and 80% for MVT recipients, respectively. The pediatric transplant recipients had significantly increased survival compared to the adults (p=<0.01). There was no significant difference between IT and MVT recipients in their development of PTLD or infection within 3 months of enterectomy. Conclusions: Graft enterectomy remains a significant event following IT and MVT, with rejection being its most common indication. MVT demonstrated a trend of higher survival and significantly higher re-transplantation rates compared to IT alone after enterectomy. Pediatric transplant recipients had higher survival rates than adult transplant recipients. Our findings highlight the need for improved immunosuppressive protocols and post-transplant monitoring to mitigate the risk of graft failure. Further research is warranted to enhance long-term survival and quality of life in this complex population. CITATION INFORMATION: Toiv A., Justus H., Sarowar A., Lee V., Marquez J., Altamura-Murgia G., Horslen S., Weiner J., Schiano T., Segovia M., Jafri S. Outcomes Following Graft Enterectomy After Intestinal and Multivisceral Transplantation: A Multicenter Analysis AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES: A. Toiv: None.

Volume

25

Issue

8

First Page

S843

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