Intestine
OPTN/SRTR 2017 Annual Data Report: Intestine
Abstract
Despite improvements in medical and surgical treatment of intestinal failure, intestine transplant continues to play an important role. In 2017, 109 intestine transplants were performed, 62 in adults and 47 in children, reflecting the changed age distribution over the past decade of candidates waitlisted for intestine and intestine-liver transplant from largely pediatric to increasing proportions of adults. In 2017, 56.0% of candidates on the intestine list at any time during the year were aged younger than 18 years, with a decrease over time in those aged younger than 6 years and an increase in those aged 6-17 years. Adults accounted for 44.0% of candidates on the list at any time during the year, with an increase since 2013 in those aged 18-34 years and a decrease in those aged 35 years or older. By age, the pretransplant mortality rate was highest for adult candidates at 7.9 per 100 waitlist-years and lowest for pediatric candidates at 3.7 per 100 waitlist-years. Patient survival varied by age and type of transplant, and was lowest for adult intestine-liver recipients (1- and 5-year survival 66.7% and 42.6%, respectively) and highest for pediatric intestine recipients (1- and 5-year survival 86.2% and 75.4%, respectively).
Introduction
Medical and surgical advances in treatments of intestinal failure have led to a continued decrease in the number of transplants over the past decade. Patient survival has improved, and morbidity associated with parenteral nutrition, including liver failure, has declined. Nevertheless, intestine transplant still plays an important role in the treatment of intestinal failure. Intestine transplants may be performed in isolation, with a liver transplant, or as part of a multi-visceral transplant including any combination of liver, stomach, pancreas, colon, spleen, and kidney. There are notable differences in patients and transplant outcomes for intestine transplants with and without liver. Information on the waiting list, transplants, and outcomes is presented for both types of transplants, referred to as intestine-liver and intestine transplants, respectively.
Waiting List
Over the past decade, the number of new patients added to the intestine transplant waiting list has steadily declined, reaching a low of 155 in 2017 compared with 301 in 2006 (Figure IN 1). Almost equal numbers of new patients were added to the waiting list for intestine (76) and for intestine-liver (79) transplants. Among the 257 prevalent patients on the waiting list at the end of 2017, 153 (59.5%) were waiting for intestine and 104 (40.5%) for intestine-liver transplant (Figure IN 2, Table IN 4). Over the past decade, the age distribution of candidates waitlisted for intestine and intestine-liver transplant shifted from primarily pediatric to increasing proportions of adults (Figure IN 3). In 2017, 56.0% of candidates on the intestine waiting list were aged younger than 18 years, with a decrease over time in those aged younger than 6 years and an increase in those aged 6-17 years. Adults account for 44.0% of candidates on the list, with an increase in those aged 18-34 years and a decrease in those aged 35 years or older. The racial/ethnic distribution has remained relatively consistent (Figure IN 5). The most common etiology of intestinal failure remained short-gut syndrome (SGS; 51.1%), which encompasses a large group of diagnoses (Figure IN 6). In 2017, 44.7% of candidates were on the waiting list for less than 1 year, 16.5% for 1 to less than 2 years, and 38.8% for 2 or more years (Figure IN 7).
Characteristics of intestine and intestine-liver candidates on the waiting list at the end of 2017 were similar with respect to age and race (Table IN 1). Intestine candidates were 58.8% female and intestine-liver candidates 38.5% female. Considering disease etiology, pseudo-obstruction, necrotizing enterocolitis, and non-congenital SGS were more common among intestine transplant candidates and enteropathies and congenital SGS were more common among intestine-liver candidates (Table IN 2). Intestine-liver candidates were more often status 1 than intestine candidates (52.9% vs. 32.7%). Listing for retransplant was more common among intestine-liver candidates than among intestine candidates (Table IN 3). Transplant rates and trends varied by candidate age and transplant type (intestine, intestine-liver) but transplant rates have decreased for all groups over the past decade (Figure IN 10). In 2017, transplant rates were higher for intestine-liver candidates than for intestine candidates. Transplant rates were 90.7 per 100 waitlist-years for pediatric intestine-liver candidates and 60.7 per 100 waitlist-years for adult intestine-liver candidates, compared with 37.7 for pediatric intestine-alone candidates and 17.5 for adult intestine-alone candidates.
Of the 84 candidates removed from the intestine waiting list in 2017, 50 (60.0%) underwent deceased donor transplant, 4 (4.8%) died, 11 (13.1%) were removed from the list because their condition improved, and 2 (2.4%) were considered too sick to undergo transplant (Table IN 5). Of the 84 candidates removed from the intestine-liver waiting list, 57 (67.9%) underwent deceased donor transplant, 11 (13.1%) died, 4 (4.8%) were removed from the list because their condition improved, and 2 (2.4%) were considered too sick to undergo transplant. Regarding 3-year outcomes, 64.8% of intestine transplant candidates listed in 2014 underwent deceased donor transplant, 5.7% died, 6.7% were removed from the list, and 22.9% were still waiting in 2017 (Figure IN 11). Of intestine-liver candidates listed in 2014, 68.6% underwent deceased donor transplant, 10.5% died, 15.2% were removed from the list, and 5.7% were still waiting in 2017 (Figure IN 12). Among candidates listed in 2016-2017, median time to transplant was 5.2 months for adult and 8.2 months for pediatric intestine-liver transplant candidates, and 4.7 months for adult intestine transplant candidates (Figure IN 13). The median was not observed for pediatric intestine transplant candidates; the median for those listed in 2014-2015 was 46.9 months.
Among candidates on the waiting list in 2016-2017, by age, pretransplant mortality was higher for adults, at 7.9 per 100 waitlist-years, and lower for pediatric patients, at 3.7 per 100 waitlist-years (Figure IN 14). Pretransplant mortality was similar for the different etiologies of organ failure (Figure IN 16). Regarding age and type of transplant, pretransplant mortality was highest for pediatric intestine-liver and lowest for adult intestine candidates (respectively, 18.8 vs. 1.9 deaths per 100 waitlist-years in 2016-2017) (Figure IN 17).
Donation
The number of recovered organs in 2017 was the lowest yet, at 108 (Figure IN 18). The largest proportions of intestine donors in 2017 were aged younger than 5 years (33.3%) and 18-34 years (30.6%) (Figure IN 19). Most intestine donors were white (67.6%, Figure IN 20). The overall rate of intestines recovered for transplant and not transplanted was 4.5% in 2016-2017 (Figure IN 22). The most common cause of death among deceased intestine donors has been head trauma, 50.9% in 2017 (Figure IN 25).
Transplant
The number of intestine transplants performed decreased to its second-lowest level, 109, in 2017 (Figure IN 26). In 2017, 19 programs were performing intestine transplants, six programs only in children, five only in adults, and eight in both adults and children (Figure IN 34). The median annual program volume was 3 intestine transplants in 2017; the 95th percentile of program volume was 20 transplants (Figure IN 35). In 2017, 67.0% of intestine transplants were performed at programs performing 10 or more transplants, and 22.0% of intestine transplants were performed at programs performing 3-9 per year (Figure IN 36).
The age distribution of intestine and intestine-liver transplant recipients changed substantially over the past decade, with adult recipients outnumbering pediatric recipients in 2017, 62 vs. 47 (Figure IN 27). In 2007, there were 87 adult recipients and 111 pediatric recipients. In 2017, almost half of intestine-liver recipients were aged younger than 18 years, 49.1% vs. 36.5% of intestine recipients (Table IN 6). SGS (congenital and non-congenital) was the main cause of disease leading to both intestine and intestine-liver transplant (Table IN 7). The proportion of recipients who waited a year or more for an intestine transplant was 15.4%, compared with 17.6% for intestine-liver recipients (Table IN 8).
Immunosuppression
Regarding induction therapy in 2017, 59.0% of intestine transplant recipients, with and without a liver, received T-cell depleting agents, 14.0% received interleukin-2 receptor antagonists, and 30.0% reported no induction (Figure IN 31). The initial (from transplant to 1 year follow-up) immunosuppression agent regimens used most commonly in 2017 were tacrolimus and steroids (44.0%) followed by tacrolimus, mycophenolate mofetil and steroids, and other (20.0%) (Figure IN 32).
Outcomes
Graft failure has declined since the late 1990s, but plateaued over the past decade. The age-, sex-, and race-adjusted graft failure rate among intestine transplant recipients was 12.7% at 6 months and 19.4% at 1 year for transplants in 2015-2016, 39.0% at 3 years for transplants in 2013-2014, 52.3% at 5 years for transplants in 2011-2012, and 66.8% at 10 years for transplants in 2007-2008 (Figure IN 37). Among intestine-liver transplant recipients, the graft failure rate was 22.7% at 6 months, and 26.8% at 1 year for transplants in 2015-2016, 36.9% at 3 years for transplants in 2013-2014, 42.0% at 5 years for transplants in 2011-2012, and 55.8% at 10 years for transplants in 2007-2008 (Figure IN 38). For intestine transplants in 2010-2012, Figure IN 39 shows 5-year graft survival curves by recipient age and Figure IN 40 shows survival by organ transplanted. For intestine transplants with or without a liver in 2010-2012, 1- and 5-year graft survival was 77.5% and 57.9%, respectively, for recipients aged younger than 18 years, and 72.0% and 43.5%, respectively, for recipients aged 18 years or older (Figure IN 39). One- and 5-year graft survival was 74.5% and 46.5%, respectively, for intestine recipients, and 74.5% and 55.2%, respectively, for intestine-liver recipients (Figure IN 40). The number of recipients alive with a functioning intestine graft steadily increased over time to 1189 on June 30, 2017; 42.4% were pediatric intestine-liver transplant recipients (Figure IN 43). The incidence of first acute rejection in the first year post-transplant varied by age group and transplant procedure. Among recipients in 2015-2016, incidence of acute rejection was highest in pediatric intestine recipients (60.5%) and lowest in adult intestine-liver recipients (31.1%) (Figure IN 44). For recipients who underwent transplant in 2005-2015, 9.6% of intestine recipients (Figure IN 46) and 6.9% of intestine-liver recipients (Figure IN 47) developed post-transplant lymphoproliferative disorder within 5 years post-transplant. Incidence was highest among recipients who were negative for Epstein-Barr virus (EBV), 11.6% of intestine recipients. Patient survival for transplants in 2010-2012 varied by age and type of transplant. Patient survival was lowest for adult intestine-liver recipients (1- and 5-year survival 66.7% and 42.6%, respectively) and highest for pediatric intestine recipients (1- and 5-year survival 86.2% and 75.4%, respectively) (Figure IN 48).
Figure List Waiting list Figure IN 1. New candidates added to the intestine transplant waiting list
Figure IN 2. Candidates listed for intestine transplant on December 31 each year
Figure IN 3. Distribution of candidates waiting for intestine transplant by age
Figure IN 4. Distribution of adults waiting for intestine transplant by sex
Figure IN 5. Distribution of candidates waiting for intestine transplant by race
Figure IN 6. Distribution of candidates waiting for intestine transplant by diagnosis
Figure IN 7. Distribution of candidates waiting for intestine transplant by waiting time
Figure IN 8. Distribution of candidates waiting for intestine transplant by medical urgency
Figure IN 9. Distribution of candidates waiting for intestine transplant by liver co-listing
Figure IN 10. Deceased donor intestine transplant rates among waitlist candidates by age and liver co-listing
Figure IN 11. Three-year outcomes for candidates waiting for intestine transplant without liver, new listings in 2014
Figure IN 12. Three-year outcomes for candidates waiting for intestine transplant with liver, new listings in 2014
Figure IN 13. Median months to intestine transplant for waitlist candidates by age
Figure IN 14. Pretransplant mortality rates among candidates waitlisted for intestine transplant by age
Figure IN 15. Pretransplant mortality rates among candidates waitlisted for intestine transplant by race
Figure IN 16. Pretransplant mortality rates among candidates waitlisted for intestine transplant by diagnosis
Figure IN 17. Pretransplant mortality rates among candidates waitlisted for intestine transplant by liver co-listing
Deceased donation Figure IN 18. Deceased intestine donor count by age
Figure IN 19. Distribution of deceased intestine donors by age
Figure IN 20. Distribution of deceased intestine donors by race
Figure IN 21. Rates of intestines recovered for transplant and not transplanted by donor age
Figure IN 22. Rates of intestines recovered for transplant and not transplanted by donor sex
Figure IN 23. Rates of intestines recovered for transplant and not transplanted by donor race
Figure IN 24. Rates of intestines recovered for transplant and not transplanted, by donor risk of disease transmission
Figure IN 25. Cause of death among deceased intestine donors Transplant
Figure IN 26. Total intestine transplants
Figure IN 27. Total intestine transplants by age
Figure IN 28. Total intestine transplants by sex
Figure IN 29. Total intestine transplants by race
Figure IN 30. Total intestine transplants by diagnosis
Figure IN 31. Induction agent use in intestine transplant recipients
Figure IN 32. Immunosuppression regimen use in adult intestine transplant recipients
Figure IN 33. Total HLA A, B, and DR mismatches among adult deceased donor intestine transplant recipients, 2013-2017
Figure IN 34. Number of centers performing adult and pediatric and adult intestine transplants by center's age mix
Figure IN 35. Annual intestine transplant center volumes, by percentile
Figure IN 36. Distribution of intestine transplants by annual center volume Outcomes
Figure IN 37. Graft failure among transplant recipients of intestine without liver
Figure IN 38. Graft failure among transplant recipients of intestine with liver
Figure IN 39. Graft survival among intestine transplant recipients, 2010-2012, by age
Figure IN 40. Graft survival among adult deceased donor intestine transplant recipients, 2010-2012, by transplant type
Figure IN 41. Graft survival among adult deceased donor intestine transplant recipients, 2012, by metropolitan vs. non-metropolitan recipient residence
Figure IN 42. Graft survival among adult deceased donor intestine transplant recipients, 2012, by recipients' distance from transplant center
Figure IN 43. Recipients alive with a functioning intestine graft on June 30 of the year, by age at transplant and procedure
Figure IN 44. Incidence of acute rejection by 1 year posttransplant among intestine transplant recipients by age and transplant type, 2015-2016
Figure IN 45. Incidence of acute rejection by 1 year posttransplant among adult intestine transplant recipients by induction status, 2015-2016
Figure IN 46. Incidence of PTLD among recipients of intestine transplant without liver by recipient EBV status at transplant, 2005-2015
Figure IN 47. Incidence of PTLD among recipients of intestine transplant with liver by recipient EBV status at transplant, 2005-2015
Figure IN 48. Patient survival among adult deceased donor intestine transplant recipients, 2010-2012, by age and transplant type
Table List Waiting list
Table IN 1. Demographic characteristics of candidates on the intestine transplant waiting list on December 31, 2017
Table IN 2. Clinical characteristics of candidates on the intestine transplant waiting list on December 31, 2017
Table IN 3. Listing characteristics of candidates on the intestine transplant waiting list on December 31, 2017
Table IN 4. Intestine transplant waitlist activity, 2017
Table IN 5. Removal reason among intestine transplant candidates, 2017 Transplant
Table IN 6. Demographic characteristics of intestine transplant recipients, 2017
Table IN 7. Clinical characteristics of intestine transplant recipients, 2017
Table IN 8. Transplant characteristics of intestine transplant recipients, 2017
Figure IN 1. New candidates added to the intestine transplant waiting list A new candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and subsequently relisted are considered new. Candidates concurrently listed at multiple centers are counted once. Active and inactive patients are included. New intestine-liver candidates are those listed for both organs on the same day. IN, intestine without liver; IN-LI, intestine-liver.
Figure IN 2. Candidates listed for intestine transplant on December 31 each year Candidates concurrently listed at multiple centers are counted once. Those with concurrent listings and active at any program are considered active. IN, intestine without liver; IN-LI, intestine-liver.
Figure IN 3. Distribution of candidates waiting for intestine transplant by age Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Age is determined at the later of listing date or January 1 of the given year. Active and inactive candidates are included.
Figure IN 4. Distribution of adults waiting for intestine transplant by sex Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Active and inactive patients are included.
Figure IN 5. Distribution of candidates waiting for intestine transplant by race Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Active and inactive candidates are included.
Figure IN 6. Distribution of candidates waiting for intestine transplant by diagnosis Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Active and inactive patients are included. SGS, short-gut syndrome.
Figure IN 7. Distribution of candidates waiting for intestine transplant by waiting time Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Time on the waiting list is determined at the earlier of December 31 or removal from the waiting list. Active and inactive candidates are included.
Figure IN 8. Distribution of candidates waiting for intestine transplant by medical urgency Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Medical urgency status is the most severe during the year. Active and inactive patients are included.
Figure IN 9. Distribution of candidates waiting for intestine transplant by liver co-listing Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Intestine-liver (IN-LI) candidates were dually listed on at least one day during the year. Active and inactive patients are included.
Figure IN 10. Deceased donor intestine transplant rates among waitlist candidates by age and liver co-listing Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting in a given year. Individual listings are counted separately. Intestine-liver co-listing is determined at the time of listing. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk are not shown.
Figure IN 11. Three-year outcomes for candidates waiting for intestine transplant without liver, new listings in 2014 Candidates waiting for intestine transplant and first listed in 2014. Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal. DD, deceased donor.
Figure IN 12. Three-year outcomes for candidates waiting for intestine transplant with liver, new listings in 2014 Candidates waiting for intestine-liver transplant and first listed in 2014. Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal. DD, deceased donor.
Figure IN 13. Median months to intestine transplant for waitlist candidates by age Observations censored on December 31, 2017; Kaplan-Meier competing risk methods used to estimate time to transplant. Analysis performed per candidate, not per listing. If an estimate is not plotted, 50% of the cohort listed in that year had not undergone transplant by the censoring date. Only the first transplant is counted.
Figure IN 14. Pretransplant mortality rates among candidates waitlisted for intestine transplant by age Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk are not shown. Age is determined at the later of listing date or January 1 of the given year.
Figure IN 15. Pretransplant mortality rates among candidates waitlisted for intestine transplant by race Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk are not shown.
Figure IN 16. Pretransplant mortality rates among candidates waitlisted for intestine transplant by diagnosis Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk are not shown. SGS, short-gut syndrome.
Figure IN 17. Pretransplant mortality rates among candidates waitlisted for intestine transplant by liver co-listing Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk are not shown. Intestine-liver co-listing is determined at the later of listing date and January 1 of the year.
Figure IN 18. Deceased intestine donor count by age Count of deceased donors whose intestines were recovered for transplant, by age at donation.
Figure IN 19. Distribution of deceased intestine donors by age Deceased donors whose intestines were recovered for transplant.
Figure IN 20. Distribution of deceased intestine donors by race Deceased donors whose intestines were recovered for transplant.
Figure IN 21. Rates of intestines recovered for transplant and not transplanted by donor age
Percentages of intestines not transplanted out of all intestines recovered for transplant.
Figure IN 22. Rates of intestines recovered for transplant and not transplanted by donor sex
Percentages of intestines not transplanted out of all intestines recovered for transplant.
Figure IN 23. Rates of intestines recovered for transplant and not transplanted by donor race
Percentages of intestines not transplanted out of all intestines recovered for transplant.
Figure IN 24. Rates of intestines recovered for transplant and not transplanted, by donor risk of disease transmission "Increased risk" is defined by criteria from the US Public Health Service Guidelines for increased risk for HIV, hepatitis B and hepatitis C transmission.
Figure IN 25. Cause of death among deceased intestine donors Deceased donors whose intestines were transplanted.
CNS, central nervous system; CVA, cerebrovascular accident.
Figure IN 26. Total intestine transplants All intestine transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients. IN, intestine without liver; IN-LI, intestine-liver.
Figure IN 27. Total intestine transplants by age All intestine transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.
Figure IN 28. Total intestine transplants by sex All intestine transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.
Figure IN 29. Total intestine transplants by race All intestine transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.
Figure IN 30. Total intestine transplants by diagnosis All intestine transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients. SGS, short-gut syndrome.
Figure IN 31. Induction agent use in intestine transplant recipients Immunosuppression at transplant reported to the OPTN. IL2-RA, interleukin-2 receptor antagonist.
Figure IN 32. Immunosuppression regimen use in adult intestine transplant recipients Immunosuppression regimen at transplant reported to the OPTN. Tac, tacrolimus. MMF, mycophenolate mofetil.
Figure IN 33. Total HLA A, B, and DR mismatches among adult deceased donor intestine transplant recipients, 2013-2017 Donor and recipient antigen matching is based on OPTN antigen values and split equivalences policy as of 2016.
Figure IN 34. Number of centers performing adult and pediatric and adult intestine transplants by center's age mix Adult centers transplanted only recipients aged 18 years or older. Functionally adult centers transplanted 80% adults or more, and the remainder were children aged 15-17 years. Mixed included adults and children of any age groups. Pediatric centers transplanted recipeints aged 0-17 years, and a small number of adults up to age 21 years.
Figure IN 35. Annual intestine transplant center volumes, by percentile Annual volume data include transplant recipients of any age.
Figure IN 36. Distribution of intestine transplants by annual center volume Based on annual volume data among recipients of any age.
Figure IN 37. Graft failure among transplant recipients of intestine without liver All recipients of deceased donor intestines, including multi-organ transplants. Patients are followed until the earliest of retransplant, graft failure, death, or December 31, 2017. Estimates computed with Cox proportional hazards models adjusted for age, sex, and race.
Figure IN 38. Graft failure among transplant recipients of intestine with liver All recipients of deceased donor intestines, including multi-organ transplants. Patients are followed until the earliest of retransplant, graft failure, death, or December 31, 2017. Estimates computed with Cox proportional hazards models adjusted for age, sex, and race.
Figure IN 39. Graft survival among intestine transplant recipients, 2010-2012, by age Intestine graft survival estimated using unadjusted Kaplan-Meier methods.
Figure IN 40. Graft survival among adult deceased donor intestine transplant recipients, 2010-2012, by transplant type Intestine graft survival estimated using unadjusted Kaplan-Meier methods. IN-LI includes intestine-liver transplants with possibly one or more additional organs; 42 recipients of intestine transplants with one or more other organs but not a liver were excluded by IN vs. IN-LI.
Figure IN 41. Graft survival among adult deceased donor intestine transplant recipients, 2012, by metropolitan vs. non-metropolitan recipient residence Patient survival estimated using unadjusted Kaplan-Meier methods. For recipients of more than one transplant during the period, only the first is considered.
Figure IN 42. Graft survival among adult deceased donor intestine transplant recipients, 2012, by recipients' distance from transplant center Patient survival estimated using unadjusted Kaplan-Meier methods. For recipients of more than one transplant during the period, only the first is considered. Distance is between the zipcode centroids of the TX center and the recipient's permanent residence, measured in nautical miles (NM).
Figure IN 43. Recipients alive with a functioning intestine graft on June 30 of the year, by age at transplant and procedure Recipients are assumed to be alive with function unless a death or graft failure is recorded. A recipient may experience a graft failure and be removed from the cohort, undergo retransplant, and re-enter the cohort.
Figure IN 44. Incidence of acute rejection by 1 year posttransplant among intestine transplant recipients by age and transplant type, 2015-2016 Acute rejection is defined as a record of acute or hyperacute rejection, as reported on the OPTN Transplant Recipient Registration or Transplant Recipient Follow-up Form. Only the first rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier competing risk method.
Figure IN 45. Incidence of acute rejection by 1 year posttransplant among adult intestine transplant recipients by induction status, 2015-2016 Acute rejection is defined as a record of acute or hyperacute rejection, as reported on the OPTN Transplant Recipient Registration or Transplant Recipient Follow-up Form. Only the first rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier competing risk method. If a recipient used both IL-2-RA and TCD agents, s/he will contribute to both of those cumulative incidence estimates.
Figure IN 46. Incidence of PTLD among recipients of intestine transplant without liver by recipient EBV status at transplant, 2005-2015 Cumulative incidence is estimated using the Kaplan-Meier competing risk method. PTLD is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus; PTLD, posttransplant lymphoproliferative disorder.
Figure IN 47. Incidence of PTLD among recipients of intestine transplant with liver by recipient EBV status at transplant, 2005-2015 Cumulative incidence is estimated using the Kaplan-Meier competing risk method. PTLD is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus; PTLD, posttransplant lymphoproliferative disorder.
Figure IN 48. Patient survival among adult deceased donor intestine transplant recipients, 2010-2012, by age and transplant type Patient survival estimated using unadjusted Kaplan-Meier methods. For recipients of more than one transplant during the period, only the first is considered.
Table IN 1 Demographic characteristics of candidates on the intestine transplant waiting list on December 31, 2017 Candidates waiting for intestines with and without liver on December 31, 2017, regardless of first listing date; multiple listings are collapsed.
Characteristic | IN, N | IN, Percent | IN-LI, N | IN-LI, Percent |
Age: < 6 years | 89 | 58.2% |
66 | 63.5% | Age: 6-17 years
| 31 | 20.3% | 16 |
15.4% | Age: 18-34 years | 18 |
11.8% | 13 | 12.5% |
Age: 35-49 years | 12 | 7.8% |
9 | 8.7% | Age: 50-64 years
| 3 | 2.0% | 0 |
0.0% | Sex: Female | 90 |
58.8% | 40 | 38.5% |
Sex: Male | 63 | 41.2% |
64 | 61.5% | Race/ethnicity: White
| 87 | 56.9% | 53 |
51.0% | Race/ethnicity: Black | 34 |
22.2% | 24 | 23.1% |
Race/ethnicity: Hispanic | 25 | 16.3% |
19 | 18.3% | Race/ethnicity: Asian
| 3 | 2.0% | 4 |
3.8% | Race/ethnicity: Other/unknown | 4 |
2.6% | 4 | 3.8% |
Geography: Metropolitan | 127 | 83.0% |
85 | 81.7% | Geography: Non-metro
| 26 | 17.0% | 19 |
18.3% | Distance: < 50 miles | 39 |
25.5% | 29 | 27.9% |
Distance: 50-<100 miles | 13 | 8.5% |
7 | 6.7% | Distance: 100-<150 miles
| 13 | 8.5% | 9 |
8.7% | Distance: 150-<250 miles | 21 |
13.7% | 13 | 12.5% |
Distance: ≥ 250 miles | 62 | 40.5% |
40 | 38.5% | Distance: Unknown
| 5 | 3.3% | 6 |
5.8% | All candidates | 153 |
100.0% | 104 | 100.0% |
Table IN 2 Clinical characteristics of candidates on the intestine transplant waiting list on December 31, 2017 Candidates waiting for intestines with and without liver on December 31, 2017, regardless of first listing date; multiple listings are collapsed. SGS, short-gut syndrome. MELD scores are given for intestine-liver candidates.
Characteristic | IN, N | IN, Percent | IN-LI, N | IN-LI, Percent |
Diagnosis: Necrotizing enterocolitis | 19 |
12.4% | 7 | 6.7% |
Diagnosis: Congenital SGS | 28 | 18.3% |
26 | 25.0% |
Diagnosis: Non-congenital SGS | 47 | 30.7% |
26 | 25.0% |
Diagnosis: Pseudo-obstruction | 20 | 13.1% |
3 | 2.9% | Diagnosis: Enteropathies
| 2 | 1.3% | 6 |
5.8% | Diagnosis: Other/unknown | 37 |
24.2% | 36 | 34.6% |
Blood type: A | 50 | 32.7% |
32 | 30.8% | Blood type: B
| 20 | 13.1% | 13 |
12.5% | Blood type: AB | 8 |
5.2% | 5 | 4.8% |
Blood type: O | 75 | 49.0% |
54 | 51.9% | IN medical urgency: Status 1
| 50 | 32.7% | 55 |
52.9% | IN medical urgency: Non-urgent
| 71 | 46.4% | 23 |
22.1% | IN medical urgency: Inactive | 32 |
20.9% | 26 | 25.0% |
LI medical urgency: Status 1A/1B | | |
2 | 1.9% |
LI medical urgency: MELD/PELD ≥ 35 | | |
16 | 15.4% |
LI medical urgency: MELD/PELD 30-34 | | |
10 | 9.6% |
LI medical urgency: MELD/PELD 15-29 | | |
47 | 45.2% |
LI medical urgency: MELD/PELD < 15 | | |
2 | 1.9% | LI medical urgency: Unknown
| | | 0 | 0.0% |
LI medical urgency: Inactive | | |
27 | 26.0% | All candidates
| 153 | 100.0% | 104 |
100.0% |
Table IN 3 Listing characteristics of candidates on the intestine transplant waiting list on December 31, 2017 Candidates waiting for intestines with and without liver on December 31, 2017, regardless of first listing date; multiple listings are collapsed.
Characteristic | IN, N | IN, Percent | IN-LI, N | IN-LI, Percent |
Transplant history: First | 139 | 90.8% |
87 | 83.7% |
Transplant history: Retransplant | 14 | 9.2% |
17 | 16.3% | Wait time: < 1 year
| 44 | 28.8% | 37 |
35.6% | Wait time: 1-< 2 years | 26 |
17.0% | 21 | 20.2% |
Wait time: 2-< 3 years | 15 | 9.8% |
13 | 12.5% | Wait time: 3-< 4 years
| 14 | 9.2% | 11 |
10.6% | Wait time: 4-< 5 years | 9 |
5.9% | 2 | 1.9% |
Wait time: ≥ 5 years | 45 | 29.4% |
20 | 19.2% | Tx type: Intestine only
| 126 | 82.4% | 0 |
0.0% | Tx type: Intestine-liver | 0 |
0.0% | 2 | 1.9% |
Tx type: Intestine-pancreas | 20 | 13.1% |
0 | 0.0% |
Tx type: Intestine-pancreas-liver | 0 | 0.0% |
93 | 89.4% |
Tx type: Intestine-pancreas-liver-kidney | 0 |
0.0% | 9 | 8.7% |
All candidates | 153 | 100.0% |
104 | 100.0% |
Table IN 4 Intestine transplant waitlist activity, 2017 Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal. Candidates who are listed, undergo transplant, and are relisted are counted more than once. Candidates are not considered to be on the list on the day they are removed. Candidates listed for multi-organ transplants are included.
Waiting list state | IN | IN-LI |
Patients at start of year | 159 | 111 |
Patients added during year | 76 | 79 |
Patients removed during year | 84 | 84 |
Patients at end of year | 151 | 106 |
Table IN 5 Removal reason among intestine transplant candidates, 2017 Removal reason as reported to the OPTN. Candidates with death dates that precede removal dates are assumed to have died waiting.
Removal reason | IN | IN-LI |
Deceased donor transplant | 50 | 57 |
Living donor transplant | 1 | 0 |
Patient died | 4 | 11 |
Patient refused transplant | 5 | 1 |
Improved, transplant not needed | 11 | 4 |
Too sick for transplant | 2 | 2 |
Other | 11 | 9 |
Table IN 6 Demographic characteristics of intestine transplant recipients, 2017 Intestine transplant recipients, including retransplants.
Characteristic | IN, N | IN, Percent | IN-LI, N | IN-LI, Percent |
Age: < 18 years | 19 | 36.5% |
28 | 49.1% | Age: 18-34 years
| 14 | 26.9% | 9 |
15.8% | Age: 35-49 years | 10 |
19.2% | 10 | 17.5% |
Age: 50-64 years | 7 | 13.5% |
8 | 14.0% | Age: ≥ 65 years
| 2 | 3.8% | 2 |
3.5% | Sex: Female | 26 |
50.0% | 24 | 42.1% |
Sex: Male | 26 | 50.0% |
33 | 57.9% | Race/ethnicity: White
| 34 | 65.4% | 39 |
68.4% | Race/ethnicity: Black | 9 |
17.3% | 10 | 17.5% |
Race/ethnicity: Hispanic | 6 | 11.5% |
7 | 12.3% | Race/ethnicity: Asian
| 3 | 5.8% | 0 |
0.0% | Race/ethnicity: Other/unknown | 0 |
0.0% | 1 | 1.8% |
Insurance: Private | 21 | 40.4% |
21 | 36.8% | Insurance: Medicaid
| 16 | 30.8% | 22 |
38.6% | Insurance: Unknown | 15 |
28.8% | 14 | 24.6% |
Geography: Metropolitan | 44 | 84.6% |
41 | 71.9% | Geography: Non-metro
| 8 | 15.4% | 16 |
28.1% | Distance: < 50 miles | 18 |
34.6% | 17 | 29.8% |
Distance: 50-<100 miles | 5 | 9.6% |
8 | 14.0% | Distance: 100-<150 miles
| 2 | 3.8% | 2 |
3.5% | Distance: 150-<250 miles | 11 |
21.2% | 8 | 14.0% |
Distance: ≥ 250 miles | 12 | 23.1% |
18 | 31.6% | Distance: Unknown
| 4 | 7.7% | 4 |
7.0% | All recipients | 52 |
100.0% | 57 | 100.0% |
Table IN 7 Clinical characteristics of intestine transplant recipients, 2017 Intestine transplant recipients, including retransplants. SGS, short-gut syndrome.
Characteristic | IN, N | IN, Percent | IN-LI, N | IN-LI, Percent |
Diagnosis: Necrotizing enterocolitis | 4 |
7.7% | 7 | 12.3% |
Diagnosis: Congenital SGS | 5 | 9.6% |
5 | 8.8% | Diagnosis: Non-congenital SGS
| 32 | 61.5% | 22 |
38.6% | Diagnosis: Pseudo-obstruction | 5 |
9.6% | 2 | 3.5% |
Diagnosis: Enteropathies | 1 | 1.9% |
4 | 7.0% | Diagnosis: Other/unknown
| 5 | 9.6% | 17 |
29.8% | Blood type: A | 19 |
36.5% | 26 | 45.6% |
Blood type: B | 4 | 7.7% |
9 | 15.8% | Blood type: AB
| 0 | 0.0% | 4 |
7.0% | Blood type: O | 29 |
55.8% | 18 | 31.6% |
Medical condition: Hospitalized in ICU | 0 |
0.0% | 7 | 12.3% |
Medical condition: Hospitalized, not ICU | 1 |
1.9% | 11 | 19.3% |
Medical condition: Not hospitalized | 51 |
98.1% | 39 | 68.4% |
IN medical urgency: Status 1 | 45 | 86.5% |
49 | 86.0% |
IN medical urgency: Non-urgent | 7 | 13.5% |
8 | 14.0% |
LI medical urgency: Status 1A/1B | | |
2 | 3.5% |
LI medical urgency: MELD/PELD ≥ 35 | | |
8 | 14.0% |
LI medical urgency: MELD/PELD 30-34 | | |
12 | 21.1% |
LI medical urgency: MELD/PELD 15-29 | | |
7 | 12.3% |
LI medical urgency: MELD/PELD < 15 | | |
23 | 40.4% | LI medical urgency: Unknown
| | | 4 | 7.0% |
LI medical urgency: Inactive | | |
1 | 1.8% | All recipients
| 52 | 100.0% | 57 |
100.0% |
Table IN 8 Transplant characteristics of intestine transplant recipients, 2017 Intestine transplant recipients, including retransplants.
Characteristic | IN, N | IN, Percent | IN-LI, N | IN-LI, Percent |
Wait time: < 31 days | 14 | 26.9% |
14 | 24.6% | Wait time: 31-60 days
| 9 | 17.3% | 6 |
10.5% | Wait time: 61-90 days | 3 |
5.8% | 6 | 10.5% |
Wait time: 3-< 6 months | 11 | 21.2% |
10 | 17.5% | Wait time: 6-< 12 months
| 7 | 13.5% | 11 |
19.3% | Wait time: 1-< 2 years | 3 |
5.8% | 5 | 8.8% |
Wait time: ≥ 2 years | 5 | 9.6% |
5 | 8.8% | Donor type: Deceased
| 51 | 98.1% | 57 |
100.0% | Donor type: Living | 1 |
1.9% | 0 | 0.0% |
Transplant history: First | 47 | 90.4% |
42 | 73.7% |
Transplant history: Retransplant | 5 | 9.6% |
15 | 26.3% | Tx type: Intestine only
| 48 | 92.3% | 0 |
0.0% | Tx type: Intestine-liver-pancreas
| 0 | 0.0% | 55 |
96.5% | Tx type: Other | 4 |
7.7% | 2 | 3.5% |
All recipients | 52 | 100.0% |
57 | 100.0% |
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