P2.56: Outcomes after pediatric intestinal transplantation: A comparative analysis between a single program and the national database

Abstract

Introduction: Thirty-seven intestinal transplant (ITx) programs have performed ≥1 pediatric ITx since 1990 according to the 2017 United Network for Organ Sharing (UNOS) database. The median number of ITx per center was 8. Our institution is an aggressive center for pediatric intestinal rehabilitation (IRP), with relatively low volumes for ITx. We hypothezised that outcomes from a medium-size program like ours compared favorably to national data. Methods: A retrospective review of all ITx done at a main pediatric IRP and ITx program was performed (2004–2019). Demographic, medical, and surgical data were collected. National data was obtained from the UNOS database (n=1500). Mann-Whitney and Chi-Square tests were used for analysis. p<0.05 was considered significant. Institutional Review Board approval was obtained (IRB #2019–2474). Results: Since 2004, 18 ITxp were performed at our institution. The proportion of girls at our center, 8/18 (44%), was identical to UNOS, 598/1346 (p=1.0). Gastroschisis was the main cause of short gut syndrome in both groups (7/18, 39% locally, vs. UNOS 341/1500, 23%, p=0.13). Mean age at transplant was similar (3.94±3.72 vs. UNOS 3.61±4.35 years, p=0.33). Mean waitlist time was longer for our patients, although not significantly (394.11±480.37 vs. UNOS 220.23±336.92 days, p=0.062). There was a trend in shorter mean distance between donor and recipient hospitals in our program (466.47±335.93 vs. UNOS 547.39±436.09 days, p=0.65) while the mean cold ischemia time was significantly shorter in our group (6.98±1.73 vs. UNOS 7.88±2.58 hours, p=0.049). There was a significant difference between groups regarding intestinal venous drainage through the portal vein for isolated small bowel ITx (3/15, 27%, vs. UNOS 247/440, 57%, p=0.005). The incidence of multivisceral transplants was significantly higher nationally (UNOS 1034/1500, 69%, vs. 3/18, 17%, p<0.001). There was no statistical difference in overall graft survival (11/18, 61%, vs. UNOS 46%, p=0.19) although it was higher in our group. There was a trend in improved overall patient survival in our patients (15/18, 83%, vs UNOS 832/1347, 62%, p=0.062). Conclusion: Timelier listing for isolated ITx is associated with a lower incidence and need for multivisceral transplantation in aggressive intestinal rehabilitation program. Shorter cold ischemia times associated with shorter travel distance between donor and recipient hospitals may contribute to higher patient and graft survival.