OPTN/SRTR 2021 Annual Data Report: Intestine

Horslen, Simon; Wood, Nicholas L.; Cafarella, Matthew; Schnellinger, Erin M.

doi:10.1016/j.ajt.2023.02.007

Cited by 20 publications

(15 citation statements)

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“…Even after listing, transplant recipients seem to live closer to their transplant center than those who are listed but not recipients, which may underscore the disparities in care based on distance from a transplant center. 94 Internationally, there remain significant equity concerns in access to both intestinal rehabilitation and transplant. Emerging economic countries have limited access to specialized intestinal rehabilitation programs.…”

Section: Eq U It Ymentioning

confidence: 99%

“…Moreover, local expertise may not be as familiar with the current state of intestine transplant, often affecting the counseling patients receive about its viability in the current era. Even after listing, transplant recipients seem to live closer to their transplant center than those who are listed but not recipients, which may underscore the disparities in care based on distance from a transplant center 94 …”

Section: Equitymentioning

confidence: 99%

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From intestinal failure to transplantation: Review on the current need for transplant indications under multidisciplinary transplant programs worldwide

Raghu,

Rumbo,

Horslen

2024

Pediatric Transplantation

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IntroductionIntestinal failure, defined as the loss of gastrointestinal function to the point where nutrition cannot be maintained by enteral intake alone, presents numerous challenges in children, not least the timing of consideration of intestine transplantation.ObjectivesTo describe the evolution of care of infants and children with intestinal failure including parenteral nutrition, intestine transplantation, and contemporary intestinal failure care.MethodsThe review is based on the authors' experience supported by an in‐depth review of the published literature.ResultsThe history of parenteral nutrition, including out‐patient (home) administration, and intestine transplantation are reviewed along with the complications of intestinal failure that may become indications for consideration of intestine transplantation. Current management strategies for children with intestinal failure are discussed along with changes in need for intestine transplantation, recognizing the difficulty in generalizing recommendations due to the high level of heterogeneity of intestinal pathology and residual bowel anatomy and function.DiscussionAdvances in the medical and surgical care of children with intestinal failure have resulted in improved transplant‐free survival and a significant fall in demand for transplantation. Despite these improvements a number of children continue to fail rehabilitative care and require intestine transplantation as life‐saving therapy or when the burden on ongoing parenteral nutrition becomes too great to bear.

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Section: Eq U It Ymentioning

confidence: 99%

Section: Equitymentioning

confidence: 99%

From intestinal failure to transplantation: Review on the current need for transplant indications under multidisciplinary transplant programs worldwide

Raghu,

Rumbo,

Horslen

2024

Pediatric Transplantation

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“…Intestinal transplant is a rare treatment of intestinal failure, with less than 100 transplants performed in 2021 in the United States. 1 The most common indications for intestinal transplant in pediatric patients include gastroschisis, volvulus, and necrotizing enterocolitis, whereas in adults, the most common indications are ischemia, Crohn's disease, and trauma. 2 Intestinal transplant has risks, including developing subsequent malignancy.…”

Section: Introductionmentioning

confidence: 99%

Nonresolving Axillary Lymphadenopathy: An Unexpected Case of Metastatic Jejunal Adenocarcinoma in a Small-Bowel Transplant Recipient Masquerading as Posttransplant Lymphoproliferative Disorder

Hemy,

Fetz,

Kim

et al. 2023

ACG Case Rep J

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Intestinal transplant is an uncommon treatment of intestinal failure that has provided many patients with reduced morbidity and mortality. However, there are associated risks, including an increased risk of cancer, such as posttransplant lymphoproliferative disorder and solid-organ malignancy. Here, we report a unique case of primary jejunal adenocarcinoma presenting initially only with axillary lymphadenopathy in a patient with recurrent posttransplant lymphoproliferative disorder after multiple solid-organ transplants, including small intestine and 2 renal transplants.

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“…1,2 Despite the latest improvements in their transplant outcomes, 5year graft survival rates remain 62% for recipients younger than 18 years and 43% for adult recipients, due to graft rejection, infection, renal failure, and secondary malignancy including posttransplant lymphoproliferative disorder. 3 Including the donor colon allograft as part of intestinal transplantation has been increasingly employed to improve fluid absorption, residue breakdown and stool patterns and eventually, to mitigate renal dysfunction. [4][5][6] Previous studies have demonstrated these physiological advantages along with quality-of-life improvements in recipients of colonic inclusion, but with conflicting results with respect to renal protection.…”

Section: Introductionmentioning

confidence: 99%

“…The last few decades have witnessed significant advances in the practicality and outcome of intestine and multivisceral transplantation 1,2 . Despite the latest improvements in their transplant outcomes, 5‐year graft survival rates remain 62% for recipients younger than 18 years and 43% for adult recipients, due to graft rejection, infection, renal failure, and secondary malignancy including posttransplant lymphoproliferative disorder 3 …”

Section: Introductionmentioning

confidence: 99%

The impact of colonic allograft inclusion on intestinal transplantation outcomes: Results from UNOS/OPTN database analysis

Matsushima,

Sasaki,

Nair

et al. 2023

Clinical Transplantation

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BackgroundOutcomes of intestinal transplantation with colon allograft (ICTx) remain controversial. We aimed to assess the outcomes of ICTx in comparison to intestinal transplantation without colon (ITx) using the UNOS/OPTN registry database.MethodsWe retrospectively reviewed 2612 patients who received primary intestinal transplants from 1998 to 2020. The rates of acute rejection (AR) within 6 months after transplant were compared between ICTx and ITx. Risk factors of 6‐month AR were examined using logistic regression model by era. Furthermore, conditional graft survival was analyzed to determine long‐term outcomes of ICTx.ResultsOf 2612 recipients, 506 (19.4%) received ICTx. Graft and patient survival in ICTx recipients were comparable to those in ITx recipients. White ICTx recipients had a higher incidence of AR within 6 months compared to ITx during the entire study period (p = .002), colonic inclusion did not increase the risk of 6‐month AR in the past decade. ICTx recipients who experienced 6‐month AR had worse graft and patient survival compared to those who did not (p <.001 and p = .004, respectively). Among patients who did not develop 6‐month AR, Cox proportional hazard model analysis revealed that colonic inclusion was independently associated with improved conditional graft survival.ConclusionsIn the recent transplant era, colonic inclusion is no longer associated with a heightened risk of 6‐month AR and may provide better long‐term survival compared to ITx when AR is absent. Risk adjustment for rejection and proper immunosuppressive therapy are crucial to maximize the benefits of colonic inclusion.

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OPTN/SRTR 2021 Annual Data Report: Intestine

Cited by 20 publications

References 0 publications

From intestinal failure to transplantation: Review on the current need for transplant indications under multidisciplinary transplant programs worldwide

From intestinal failure to transplantation: Review on the current need for transplant indications under multidisciplinary transplant programs worldwide

Nonresolving Axillary Lymphadenopathy: An Unexpected Case of Metastatic Jejunal Adenocarcinoma in a Small-Bowel Transplant Recipient Masquerading as Posttransplant Lymphoproliferative Disorder

The impact of colonic allograft inclusion on intestinal transplantation outcomes: Results from UNOS/OPTN database analysis

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