Improved Graft Survival Research Articles

Matching for HLA-DR excluding diabetogenic HLA-DR3 and HLA-DR4 predicts insulin independence after pancreatic islet transplantation.

In pancreatic islet transplantation, the exact contribution of human leukocyte antigen (HLA) matching to graft survival remains unclear. Islets may be exposed to allogenic rejection but also the recurrence of type 1 diabetes (T1D). We evaluated the HLA-DR matching, including the impact of diabetogenic HLA-DR3 or HLA-DR4 matches. We retrospectively examined the HLA profile in 965 transplant recipients and 2327 islet donors. The study population was obtained from patients enrolled in the Collaborative Islet Transplant Registry. We then identified 87 recipients who received a single-islet infusion. Islet-kidney recipients, 2nd islet infusion, and patients with missing data were excluded from the analysis (n=878). HLA-DR3 and HLA-DR4 were present in 29.7% and 32.6% of T1D recipients and 11.6% and 15.8% of the donors, respectively. We identified 52 T1D islet recipients mismatched for HLA-DR (group A), 11 with 1 or 2 HLA-DR-matches but excluding HLA-DR3 and HLA- DR4 (group B), and 24 matched for HLA-DR3 or HLA-DR4 (group C). Insulin-independence was maintained in a significantly higher percentage of group B recipients from year one through five post-transplantation (p<0.01). At five-year post-transplantation, 78% of group B was insulin-independent compared to 24% (group A) and 35% (group C). Insulin-independence correlated with significantly better glycemic control (HbA1c <7%), fasting blood glucose, and reduced severe hypoglycemic events. Matching HLA-A-B-DR (≥3) independently of HLA- DR3 or HLA-DR4 matching did not improve graft survival. This study suggests that matching HLA-DR but excluding the diabetogenic HLA-DR3 and/or 4 is a significant predictor for long-term islet survival.

The effectiveness and safety of antibody induction immunosuppression in a large cohort of United States pediatric liver transplant recipients

Data on the potential benefits and risks of induction therapy in pediatric liver transplantation (LT) are limited. This was a retrospective cohort study of 2748 pediatric LT recipients at 26 children’s hospitals between January 1, 2006 to May 31, 2017 using data from the pediatric health information system linked to the United Network for Organ Sharing database. The induction regimen was obtained from the pediatric health information system day-by-day pharmacy resource utilization. Cox proportional hazards evaluated the association of induction regimen (none/corticosteroid-only, nondepleting, and depleting) on patient and graft survival. Additional outcomes, including opportunistic infections and posttransplant lymphoproliferative disorder, were studied using multivariable logistic regression. Overall, 64.9% received none/corticosteroid-only induction, whereas 28.1% received nondepleting, 8.3% received depleting, and 2.5% other antibody regimens. Differences in patient characteristics were small, but center practices were heterogeneous. Compared with none/corticosteroid-only induction, nondepleting induction was associated with reduced acute rejection (odd ratio [OR], 0.53; P <.001) but with the increased posttransplant lymphoproliferative disorder (OR, 1.75; P =.021). Depleting induction was associated with improved graft survival (hazard ratio [HR], 0.64; P =.028) but with increased noncytomegalovirus opportunistic infections (OR, 1.46; P =.046). Depleting induction is underused yet may offer long-term benefits in this large multicenter cohort. Greater consensus guidance in this aspect of pediatric LT care is warranted.

Adult spinal cord tissue transplantation combined with local tacrolimus sustained‐release collagen hydrogel promotes complete spinal cord injury repair

The strategy of replacing a completely damaged spinal cord with allogenic adult spinal cord tissues (aSCs) can potentially repair complete spinal cord injury (SCI) in combination with immunosuppressive drugs, such as tacrolimus (Tac), which suppress transplant rejection and improve graft survival. However, daily systemic administration of immunosuppressive agents may cause harsh side effects. Herein, a localized, sustained Tac-release collagen hydrogel (Col/Tac) was developed to maximize the immune regulatory efficacy but minimize the side effects of Tac after aSC transplantation in complete SCI recipients. Thoracic aSCs of rat donors were transplanted into the complete thoracic spinal cord transection rat recipients, after which Col/Tac hydrogel was implanted. The Tac-encapsulated collagen hydrogel exhibited suitable mechanical properties and long-term sustained Tac release behaviour. After Col/Tac hydrogel implantation in SCI rats with aSC transplantation, the recipients' survival rate significantly improved and the side effects on tissues were reduced compared with those with conventional Tac medication. Moreover, treatment with the Col/Tac hydrogel exhibited similarly reduced immune rejection levels by regulating immune responses and promoted neurogenesis compared to daily Tac injections, and thus improved functional restoration. Localized delivery of immunosuppressive agents by the Col/Tac hydrogel may be a promising strategy for overcoming immune rejection of transplants, with significant potential for clinical application in the future.

Predictive value of portal fibrosis and inflammation in transplanted liver grafts treated with hypothermic oxygenated perfusion.

Hypothermic oxygenated perfusion (HOPE) has become widespread for the preservation of liver grafts, making tangled the relationship among the use of extended criteria donors (ECD), graft histology and transplant outcome. To prospectively validate the impact of the graft histology on transplant outcome in recipient receiving liver grafts from ECD after HOPE. Ninety-three ECD grafts were prospectively enrolled; 49 (52.7 %) were perfused with HOPE according to our protocols. All clinical, histological and follow-up data were collected. Grafts with portal fibrosis stage ≥3 according to Ishak's (evaluated with Reticulin stain) had a significantly higher incidence of early allograft dysfunction (EAD) and 6-month-dysfunction (p=0.026 and p=0.049), with more days in Intensive Care Unit (p=0.050). Lobular fibrosis correlated with post-liver transplant kidney function (p=0.019). Moderate-to-severe chronic portal inflammation was correlated with graft survival on both multivariate and univariate analyses (p<0.001), but this risk factor is sensibly reduced by the execution of HOPE. The use of liver grafts with portal fibrosis stage ≥3 implies a higher risk of post-transplant complications. Portal inflammation represents an important prognostic factor as well, but the execution of HOPE represents a valid tool to improve graft survival.

Analysis of induction and maintenance immunosuppression choices in the US during the first year post kidney transplant for patients over 70

Rates of kidney transplantation in patients over 70 years of age have steadily increased over the last 20 years, however age-appropriate immunosuppression regimens in the elderly remain unclear. Investigators utilized the SRTR database to evaluate elderly kidney transplant recipients’ outcomes against a younger population. Post-transplant outcomes measured at an approximately 1-year time interval included graft survival, patient survival, rejection, malignancy, and serum creatinine. Elderly patient survival was improved for those patients that were on dialysis for less than 1 year (95.4% vs. 91.4% p &lt; .01). Patients able to be maintained on CNI immunosuppression regimens also had improved graft survival compared to those managed with other immunosuppression (95.5% vs. 91.1%, p &lt; .01). Patients maintained on mTOR inhibitors had the lowest patient survival (85.5% vs. 92.6%, p &lt; .01). The choice of induction therapy did not affect long term patient or graft survival. These results translated to investigators’ own centers in patients over 60. Results for the SRTR database showed that minimizing time on dialysis prior to transplant improved graft and patient survival, while the type of induction agent had minimal effect on all outcomes at the time of follow-up. The results also support the use of CNI’s and belatacept for maintenance immunosuppression but did not encourage the use of mTOR inhibitors.

Complement inhibition alleviates donor brain death-induced liver injury and posttransplant cascade injury by regulating phosphoinositide 3-kinase signaling

Brain death (BD) donors are the primary source of donor organs for liver transplantation. However, the effects of BD on donor livers and outcomes after liver transplantation remain unclear. Here, we explored the role of complement and the therapeutic effect of complement inhibition in BD-induced liver injury and posttransplantation injury in a mouse BD and liver transplantation model. For complement inhibition, we used complement receptor 2 (CR2)-Crry, a murine inhibitor of C3 activation that specifically targets sites of complement activation. In the mouse model, BD resulted in complement activation and liver injury in donor livers and a cascade liver injury posttransplantation, mediated in part through the C3a-C3aR (C3a receptor) signaling pathway, which was ameliorated by treatment with CR2-Crry. Treatment of BD donors with CR2-Crry improved graft survival, which was further improved when recipients received an additional dose of CR2-Crry posttransplantation. Mechanistically, we determined that complement inhibition alleviated BD-induced donor liver injury and posttransplant cascade injury by regulating phosphoinositide 3-kinase (PI3K) signaling pathways. Together, BD induced donor liver injury and cascade injury post-transplantation, which was mediated by complement activation products acting on PI3K signaling pathways. Our study provides an experimental basis for developing strategies to improve the survival of BD donor grafts in liver transplantation.

A pharmacist-led intervention to improve kidney transplant recipient outcomes and identify patients at risk of highly variable trough tacrolimus levels: a cohort study

ObjectivesGiven the positive impact of appropriate medication management on graft outcome and therefore of patient survival and graft function, the pharmacist’s role in the kidney transplantation team has evolved over...

Localized cytotoxic T cell–associated antigen 4 and antioxidant islet encapsulation alters macrophage signaling and induces regulatory and anergic T cells to enhance allograft survival

The loss of functional β-cell mass is a hallmark of type 1 diabetes. Islet transplantation represents a promising alternative approach, but immune-mediated graft destruction remains a major challenge. We sought to use islet encapsulation technologies to improve graft survival and function without systemic immunosuppression. We hypothesized islet encapsulation with nanothin coatings consisting of tannic acid (TA), an antioxidant; poly(N-vinylpyrrolidone) (PVPON), a biocompatible polymer; and cytotoxic T cell–associated antigen 4 immunoglobulin (CTLA-4-Ig), an inhibitory immune receptor, will elicit localized immunosuppression to prolong islet allograft function and suppress effector T cell responses. In the absence of systemic immunosuppression, we demonstrated (PVPON/TA/CTLA-4-Ig)-encapsulated NOD.Rag islet grafts maintain function significantly longer than control IgG-containing (PVPON/TA/IgG) and nonencapsulated controls after transplantation into diabetic C57BL/6 mice. This protection coincided with diminished proinflammatory macrophage responses mediated by signal transducer and activator of transcription 1 signaling, decreased proinflammatory T cell effector responses, and CTLA-4-Ig-specific concomitant increases in anergic CD4+ T cells and regulatory T cells. Our results provide evidence that conjugation of CTLA-4-Ig to (PVPON/TA) coatings can suppress T cell activation, enhance regulatory T cell populations, prolong islet allograft survival, and induce localized immunosuppression after transplantation.

Extracorporeal Photopheresis Improves Graft Survival in a Full-Mismatch Rat Model of Kidney Transplantation.

Extracorporeal photopheresis (ECP) is an immunomodulatory therapy based on the infusion of autologous cellular products exposed to ultraviolet light (UV) in the presence of a photosensitizer. The study evaluates the ECP efficacy as induction therapy in a full-mismatch kidney transplant rat model. Dark Agouti to Lewis (DA-L) kidney transplant model has been established. ECP product was obtained from Lewis rat recipients after DA kidney graft transplantation (LewDA). Leukocytes of those LewDA rats were exposed to 8-methoxy psoralen, and illuminated with UV-A. The ECP doses assessed were 10 × 106 and 100 × 106 cells/time point. Lewis recipients received seven ECP infusions. DA-L model was characterized by the appearance of donor-specific antibodies (DSA) and kidney function deterioration from day three after kidney transplant. The dysfunction progressed rapidly until graft loss (6.1 ± 0.5days). Tacrolimus at 0.25mg/kg prolonged rat survival until 11.4 ± 0.7days (p = 0.0004). In this context, the application of leukocytes from LewDA sensitized rats accelerated the rejection (8.7 ± 0.45, p = 0.0012), whereas ECP product at high dose extended kidney graft survival until 26.3 ± 7.3days, reducing class I and II DSA in surviving rats. ECP treatment increases kidney graft survival in full-mismatch rat model of acute rejection and is a suitable immunomodulatory therapy to be explored in kidney transplantation.

Transforming Liver Transplant Outcome Prediction: An Innovative Machine Learning Approach for Improved Graft Survival Assessment

Transforming Liver Transplant Outcome Prediction: An Innovative Machine Learning Approach for Improved Graft Survival Assessment

Engineering thixotropic supramolecular gelatin-based hydrogel as an injectable scaffold for cell transplantation

Despite many efforts focusing on regenerative medicine, there are few clinically-available cell-delivery carriers to improve the efficacy of cell transplantation due to the lack of adequate scaffolds. Herein, we report an injectable scaffold composed of functionalized gelatin for application in cell transplantation. Injectable functionalized gelatin-based hydrogels crosslinked with reversible hydrogen bonding based on supramolecular chemistry were designed. The hydrogel exhibited thixotropy, enabling single syringe injection of cell-encapsulating hydrogels. Highly biocompatible and cell-adhesive hydrogels provide cellular scaffolds that promote cellular adhesion, spreading, and migration. The in vivo degradation study revealed that the hydrogel gradually degraded for seven days, which may lead to prolonged retention of transplanted cells and efficient integration into host tissues. In volumetric muscle loss models of mice, cells were transplanted using hydrogels and proliferated in injured muscle tissues. Thixotropic and injectable hydrogels may serve as cell delivery scaffolds to improve graft survival in regenerative medicine.

An interleukin 6-based genetic risk score strengthened with interleukin 10 polymorphisms associated with long-term kidney allograft outcomes

Of all kidney transplants, half are still lost in the first decade after transplantation. Here, using genetics, we probed whether interleukin 6 (IL-6) could be a target in kidney transplantation to improve graft survival. Additionally, we investigated if a genetic risk score (GRS) based on IL6 and IL10 variants could improve prognostication of graft loss. In a prospective cohort study, DNA of 1271 donor-recipient kidney transplant pairs was analyzed for the presence of IL6, IL6R, IL10, IL10RA, and IL10RB variants. These polymorphisms and their GRS were then associated with 15-year death-censored allograft survival. The C|C-genotype of the IL6 polymorphism in donor kidneys and the combined C|C-genotype in donor-recipient pairs were both associated with a reduced risk of graft loss (p=.043 and p=.042, respectively). Additionally, the GRS based on IL6, IL6R, IL10, IL10RA, and IL10RB variants was independently associated with the risk of graft loss (HR 1.53, 95%-CI [1.32-1.84]; p<.001). Notably, the GRS improved risk stratification and prediction of graft loss beyond the level of contemporary clinical markers. Our findings reveal the merits of a polygenic IL-6-based risk score strengthened with IL-10- polymorphisms for the prognostication and risk stratification of late graft failure in kidney transplantation.

Human stem cell derived beta-like cells engineered to present PD-L1 improve transplant survival in NOD mice carrying human HLA class I.

There is a critical need for therapeutic approaches that combine renewable sources of replacement beta cells with localized immunomodulation to counter recurrence of autoimmunity in type 1 diabetes (T1D). However, there are few examples of animal models to study such approaches that incorporate spontaneous autoimmunity directed against human beta cells rather than allogenic rejection. Here, we address this critical limitation by demonstrating rejection and survival of transplanted human stem cell-derived beta-like cells clusters (sBCs) in a fully immune competent mouse model with matching human HLA class I and spontaneous diabetes development. We engineered localized immune tolerance toward transplanted sBCs via inducible cell surface overexpression of PD-L1 (iP-sBCs) with and without deletion of all HLA class I surface molecules via beta-2 microglobulin knockout (iP-BKO sBCs). NOD.HLA-A2.1 mice, which lack classical murine MHC I and instead express human HLA-A*02:01, underwent transplantation of 1,000 human HLA-A*02:01 sBCs under the kidney capsule and were separated into HLA-A2 positive iP-sBC and HLA-class I negative iP-BKO sBC groups, each with +/- doxycycline (DOX) induced PD-L1 expression. IVIS imaging showed significantly improved graft survival in mice transplanted with PD-L1 expressing iP-sBC at day 3 post transplantation compared to controls. However, luciferase signal dropped below in vivo detection limits by day 14 for all groups in this aggressive immune competent diabetes model. Nonetheless, histological examination revealed significant numbers of surviving insulin+/PD-L1+ sBCs cells for DOX-treated mice at day 16 post-transplant despite extensive infiltration with high numbers of CD3+ and CD45+ immune cells. These results show that T cells rapidly infiltrate and attack sBC grafts in this model but that significant numbers of PD-L1 expressing sBCs manage to survive in this harsh immunological environment. This investigation represents one of the first in vivo studies recapitulating key aspects of human autoimmune diabetes to test immune tolerance approaches with renewable sources of beta cells.

Improved graft survival in liver transplantation recipients with three-dimensional printing of intra-abdominal cavity to prevent large-for-size syndrome: propensity-score matched analysis

Improved graft survival in liver transplantation recipients with three-dimensional printing of intra-abdominal cavity to prevent large-for-size syndrome: propensity-score matched analysis

PSUN273 Endocrine Management of Renal Transplant Patients: A Role in Successful Graft Survival? Updated Data

Abstract Introduction Graft survival after renal transplantation is dependent upon multiple factors. Many patients undergoing renal transplantation have endocrine disorders, such as pre-existing diabetes and metabolic bone disease, and can develop post-transplant diabetes (PTDM) and hyperlipidemia. Diabetes, lipid abnormalities, and hypovitaminosis D have been associated negatively with patient and graft survival1, 2. Our kidney transplant program ranks among the top 3 programs in the country for its kidney transplant outcomes according to the data by the Scientific Registry of Transplant Recipients. We hypothesized that our multidisciplinary team management of these patients was one factor in this success. We reported our findings in 2017. Here we present follow up data through 2021 on this same cohort. Methods Over 20 years ago members of the Endocrine division began attending the transplant clinic in the Department of Surgery to facilitate patient care. In 2016 we identified all patients followed over the previous 3 years. Charts were reviewed after IRB approval and data collected retrospectively. Data for this cohort has been updated through 2021. Results A total of 241 patients were seen (of 626 total transplant recipients). There were 154 males, 87 females, and the average age at transplant was 47 years. Diabetes was present prior to transplant in 118 (46.6%) and an additional 51 (21%) developed PTDM. For patients with diabetes, the pre transplant A1c fell from 7.5 ± 1.6% to 7 ± 1.2% at 6 months (p = 0.13). At 6 months, the A1c was 6.45% for those who had developed PTDM. Pre-transplant, 79 (31%) were on some form of lipid lowering therapy. Post-transplant, 216 (90%) had hyperlipidemia: 186 (77%) were on a statin, in addition to 51(21%) on fish oil, 28 (12%) on gemfibrozil, and 4 (1.5%) on niacin. The average Vitamin D level within 1 year post-transplant was 19.9 ± 8, but increased to 33± 14 at most recent visits (P &amp;lt; .01). Of 217 patients over the age of 40, 93 (43%) have had a DEXA: Osteoporosis was diagnosed in 43 patients and osteopenia in an additional 31. Of these patients, 34 are or have been on treatment (bisphosphonate). Conclusions We believe that multidisciplinary team management of post renal transplant patients can improve graft survival. While our improvement in A1c values at 6 months post-transplant was not statistically significant, the trend was clearly there even considering potential artefactual lowering of the A1c in renal failure patients. We did demonstrate improvement in Vitamin D levels and frequency of statin use. We also found that there remain some barriers for care (evidence, for example, by many patients not having Vitamin D levels or DEXA). Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

A Small Molecule Activator of Lyn Improves the Outcomes of Islet Transplantation in Mice

Islet transplantation can achieve insulin independence in individuals with type 1 diabetes. However, islets derived from multiple donors are often required, and functional beta cells are lost early after transplantation. There is thus a need for strategies to improve graft survival and function. Our lab has recently characterized Lyn as a critical regulator of beta-cell proliferation and survival. We herein sought to test the hypothesis that pharmacological activation of Lyn improves the outcome of islet transplantation in mice.

Mouse Sertoli Cells Inhibit Humoral-Based Immunity

Transplantation is used to treat many different diseases; however, without the use of immunosuppressants, which can be toxic to the patient, grafted tissue is rejected by the immune system. Humoral immune responses, particularly antibodies and complement, are significant components in rejection. Remarkably, Sertoli cells (SCs), immunoregulatory testicular cells, survive long-term after transplantation without immunosuppression. The objective of this study was to assess SC regulation of these humoral-based immune factors. Mouse SCs survived in vitro human complement (model of robust complement-mediated rejection) and survived in vivo as allografts with little-to-no antibody or complement fragment deposition. Microarray data and ELISA analyses identified at least 14 complement inhibitory proteins expressed by mouse SCs, which inhibit complement at multiple points. Interestingly, a mouse SC line (MSC-1), which was rejected by day 20 post transplantation, also survived in vitro human complement, showed limited deposition of antibodies and complement, and expressed complement inhibitors. Together this suggests that SC inhibition of complement-mediated killing is an important component of SC immune regulation. However, other mechanisms of SC immune modulation are also likely involved in SC graft survival. Identifying the mechanisms that SCs use to achieve extended survival as allografts could be utilized to improve graft survival.

The Role of Macrophages in Sertoli Cell Transplant Survival Without the Use of Immunosuppressive Drugs

INTRODUCTION: Islet transplantation is an innovative method to treat diabetes; however, the immunosuppressive drugs necessary to prevent transplant rejection make patients susceptible to infections, cancer, and are even detrimental to the transplanted islet function. Sertoli cells (SC) are immune-privileged testicular cells that have potential as an alternative to immunosuppressive therapy, because they have been shown to protect co-transplanted islets without the use of chronic immunosuppressive drugs. However, the mechanisms by which SC extend graft survival remain unknown. Because the successful SC/islet co-grafts contain macrophages, we examined the role of macrophages in SC transplant survival. METHODS: C57BL6 SC or MSC-1 cells (rejecting control mouse SC line) (donors) were transplanted under the left kidney capsule of control or macrophage-depleted (MOKO) BALB/c mice (recipients). Macrophages were depleted using chlorate liposome injections. Grafts were collected at day 20 post-transplantation and analyzed for cell survival by immunohistochemistry (IHC) and macrophage depletion by IHC and flow cytometry. RESULTS: Macrophages were present in control recipients and confirmed depleted in MOKO recipients. In control recipients, 100% of the SC grafts survived, but 100% of the MSC-1 grafts were rejected. In MOKO recipients, SC grafts exhibited 100% survival. Surprisingly, 56% of MSC-1 grafts survived, which is especially interesting because normally they are rejected. CONCLUSION: These results indicate that macrophages are not required for SC survival; however, macrophages may be involved in graft rejection. Understanding the role of macrophages in transplantation could lead to improved graft survival and increased viability of islet transplants.

Comparison of mid-term clinical outcome in heart transplantation patients using mycophenolate mofetil vs. enteric-coated mycophenolate sodium.

BackgroundMycophenolate mofetil (MMF) is a prodrug of mycophenolic acid (MPA) and a key immunosuppressant for improving graft survival in patients with heart transplantation (HTx). However, dose reduction or interruption is occasionally needed due to gastrointestinal (GI) side effects. Enteric-coated mycophenolate sodium (EC-MPS) is an alternative form of MPA delivery to improve GI tolerability. In the present study, the efficacy of EC-MPS compared with MMF in HTx patients was investigated.MethodsIn this retrospective study, the Korean Organ Transplant Registry (KOTRY) data were used to analyze the efficacy and rejection rate of MMF and EC-MPS. A total of 611 patients was enrolled from 2014 to February of 2021. Patients were divided based on the use of MMF or EC-MPS at 6 months post-HTx. Patients who were not prescribed MMF or EC-MPS were excluded. Graft survival, all-cause mortality, and treated rejection were compared between the two groups. All statistical analyses were performed using SPSS; characteristics were compared using Pearson chi-square test and survival rate with Kaplan-Meier plot and log-rank test.ResultsA total of 510 HTx patients was analyzed (mean age: 51.74 ± 13.16 years, males: 68.2%). At 6 months after HTx, 78 patients were taking EC-MPA (12.8%) and 432 patients were taking MMF (70.7%). The median follow-up was 42.0 months (IQR: 21.7–61.0 months). Post-HTx outcomes including overall survival, all cause mortality, acute cell mediated rejection (ACR), acute antibody mediated rejection (AMR), treated rejection, and cardiac allograft vasculopathy (CAV) were comparable between the two groups during follow-up.ConclusionNotable differences were not observed in overall survival, all cause mortality, ACR, AMR, treated rejection, and CAV between MMF and EC-MPS groups. Efficacy of EC-MPS was similar to that of MMF in HTx patients during mid-term follow up after HTx.

Living Donor Intestinal Transplantation: Recipient Outcomes.

Objective:To examine outcomes of living-donor intestinal transplant (LDITx) recipients.Background:LDITx is not routinely performed because of surgical risks to the donor and the potential inferior physiologic performance of the segmental graft. However, data on the effectiveness of LDITx are scarce.Design:This retrospective cohort study included patients undergoing LDITx between May 1999 and December 2021 in intestinal transplant programs in 2 university-affiliated hospitals in China.Results:Actuarial survival rates were 80%, 72.7%, 66.7% for patient and 72.4%, 63.6%, 60% for graft at 1, 3, and 5 years, respectively. Recipients with >3/6 HLA-matched grafts had superior patient and graft survival rates than those with ≤3/6 HLA-matched grafts (P<0.05). There were 12 deaths among the recipients, with infection being the leading cause (41.7%), followed by rejection (33.3%), surgical complications (16.7%), and others (8.3%). There were 16 graft losses among the recipients, with acute cellular rejection being the predominant cause (37.5%), followed by infection (25%), technical failure (12.5%), chronic rejection (12.5%), and others (12.5%). With an average follow-up of 3.7 (range, 0.6–23) years, the rates of acute and chronic rejection were 35% and 5%, and the rate of cytomegalovirus disease and post-transplant lymphoproliferative disease were 5% and 2.5%, respectively. Of the 40 patients, 28 (70%) are currently alive and have achieved enteral autonomy.Conclusions:LDITx is a valuable treatment option for patients with end-stage intestinal failure. Improved immunosuppression, better HLA matching, and shorter cold ischemia times were associated with reduced rates of rejection, viral-mediated infection and improved graft survival.