Evolution of intestinal and multivisceral transplantation: A thirty-year United States perspective.
The field of intestinal transplantation has significantly changed since the report of the first successful transplant in 1988. This report seeks to describe the trends in intestinal transplantation utilization and outcomes over time in the United States of America.We use the cohort of intestinal and multivisceral transplants 1990- Feb 2020 in the UNOS STAR dataset. Eras were defined as 1990-1999, 2000-2009, 2010- Feb 2020. Summary statistics were calculated by era. Patient and death-censored graft survival were assessed by era, stratified by pediatric (<18 years at transplant) and adult recipients.A total of 3035 transplants were performed: 398 in the first era, 1485 in the second, 1235 in the third. The proportion of adult recipients increased over time (35 %, 44 %, 59 % respectively). Fewer livers were included for adults over time (42.8 %, 37.3 %, 36.9 %). One- and five-year patient survival improved over time in children, while adult survival plateaued. A similar trend was observed in death-censored graft survival.A greater proportion of intestinal transplants are now performed in adults, perhaps as a result of improvements in the intestinal rehabilitation of pediatric patients. Graft and patient survival has improved for pediatric patients but not for adults in the past decade, highlighting the ongoing need for improving long-term outcomes in adult recipients.
