Temporal and geographical trends of intestinal transplantation in the USA.
Segovia M, Jafri S, Summers B, Schiano T, Pietrowsky T, Al-Osaimi A, Mavis A, and Horslen S. Temporal and geographical trends of intestinal transplantation in the USA. Am J Transplant 2018; 18:277-278.
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
Intestinal transplantation (IT) is uncommon compared to other organ transplants. We examined the temporal and geographical trends of centers that perform IT in the USA We obtained information about IT centers from the OPTN and analyzed it by era and age of recipients. The analysis was divided into 3 periods:1)1990-1999, 2)2000-2009, 3)2010- September 2017. The country was divided into census (West, Midwest, Northeast, South) and UNOS regions. High volume(HV) centers were those performing an average of 10 or more IT per year. Pediatric patients were those <18 years old In 1990, 2 UNOS regions had active IT centers: 2 and 8. HV centers were: 1 during period 1 (UNOS region 3), 6 during period 2 (regions 2, 3, 8, 10), 5 during period 3 (regions 2, 3, 8, 9, 10). Pediatric patients accounted for 65.3% of 398 IT performed during period 1, 56.3% of 1485 IT in period 2 and 40.7% of 1013 IT in period 3. Centers doing at least 1 IT in any given year remained relatively constant in number during the 3 periods. The Midwest had the greater stability in number of centers doing an IT in any given year, as have UNOS regions 1, 3, 7, 9. The number of centers doing IT every year almost doubled from period 1 to 2 and since then has remained relatively stable. The location of these centers has remained stable with UNOS regions 2 and 10 currently accounting for 53.8% of them. The number of HV centers has increased throughout the years but not in the West. There was a 373% increase in the number of IT from period 1 to 2. This decreased in period 3. During periods 1 and 2, UNOS regions 2, 3, 8 accounted for 69.7% of all IT. During period 3, regions 2, 8, 10 accounted for 65.3% The number of centers doing at least 1 IT at any given year remained consistent during the 3 periods. Transplant patterns differ by region with fewer HV centers in the West. The number of IT grew in adults between periods 1 and 2 and then remained consistent in period 3 while the number of pediatric cases initially grew but then fell dramatically between periods 2 and 3. This likely reflects widespread implementation and improvement in intestinal rehabilitation. These numbers show there has been an evolution in IT from being experimental before 1990 to the standard of care for patients with specific indications nowadays performed in centers with significant expertise.