Surveillance with Protocol Biopsies for Rejection Significantly Impacts Survival Following Intestine Transplant

Document Type

Conference Proceeding

Publication Date

8-22-2022

Publication Title

Am J Transplant

Abstract

Purpose: Frequent surveillance biopsy is required on the first month post intestinal transplant(IT) due to high-risk of acute rejection. However, the utility and the frequency of surveillance biopsy post 1-month is often determined by the physician and the institutions' preference. Thus, we aimed to report IT outcomes and clinical significance of surveillance biopsy at a single tertiary care center. Methods: In this 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. 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 post-transplant, 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 transplant enterectomy at a median time of 12 (8-36) months post-transplant. In general, there was a 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). There was a non-significant trend with longer median length of hospital stay in patients with greater number of biopsies. Conclusions: Our results indicate evidence of survival benefit of increased protocol biopsies. Future studies with larger sample size are required to validate our results.

Volume

22

First Page

484

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