P3B.15: Results in adult small bowel transplantation after 15 years of experience in University Hospital 12 de Octubre, Madrid

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Introduction: A very limited number of groups perform intestinal (IT) and multivisceral (MVT) transplantation worldwide, and even fewer remain active nowadays. IT and MVT results are somewhat worse than those after other types of solid organ transplantation (SOT), thus patient selection remains extremely important. Methods: From December 2004 to January 2019 we have assessed 105 patients as potential candidates, most of them not eligible; and have performed 31 transplants in 29 patients (21 ITx and 8 MVtx). Almost eighty percent had undergone some previous surgical approach (average 4 ± 2,7). 40% required home parenteral nutrition (HPN) and almost 86% had several complications related to it (thrombosis, sepsis, multiple central line removals…) Results: Short bowel syndrome (SBS) was found in 60 % (18/29) of the patients. Familial Adenomatous Polyposis (FAP) with unresectable desmoid tumors (31%) and ischemia (18%) were the most common indications. Complications were very frequent: rejection (AR; 63.6%) and infection (51%, 37% mesh-related) were the main causes of death in the early postoperative period (0–6 months); and finally renal failure (56%) a frequent cause of morbidity and prolonged hospital stay. Graft was removed in 7 patients (24%; 7/29) mainly due to severe AR as well as lymphoproliferative tumors and vascular technical problems. although The overall graft loss rate was of 55% (17/31, 10 deaths with functioning grafts). After a mean follow up of 65 ± 61 months for patients and 60 ± 58 months for grafts, our actuarial survival for patients and grafts at 1, 3, 5 and 10 years was 73%, 62.4%, 55%, 51% and 66%, 62%, 55%, 50% respectively. Actuarial patient and graft survival at 3 and 5 years excluding those patients who died during the first year after transplant was 85,4% / 75% and 81% / 71% respectively. 31% of the recipients died during the first year post-transplantation. Those recipients who survive beyond the first year post-transplantation are more likely to be alive. Conclusions: Small bowel transplantation is an excellent treatment for intestinal failure in selected patients. Our aim is to perform the SBT as early as possible in order to avoid established malnutrition and operate on less deteriorated patients, with not so poor performance status, and fewer potential complications due to HPN.