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

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

Outcomes

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

A line plot for candidates listed for intestine transplant on december 31 each year; the in category increases by 41.7% from 108 candidates at 2006 to 153 candidates at 2017; the in to li category decreases by 14.0% from 121 candidates at 2006 to 104 candidates at 2017; and the all category increases by 12.2% from 229 candidates at 2006 to 257 candidates at 2017. — **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.

A line plot for distribution of candidates waiting for intestine transplant by age; the less than 6 category decreases by 45.3% from 53.7 percent at 2006 to 29.4 percent at 2017; the 6 to 17 category increases by 91.5% from 13.9 percent at 2006 to 26.6 percent at 2017; the 18 to 34 category increases by 60.0% from 11.5 percent at 2006 to 18.4 percent at 2017; and the greater than or equal to 35 category increases by 22.6% from 20.9 percent at 2006 to 25.6 percent at 2017. — **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.

A line plot for distribution of adults waiting for intestine transplant by sex; the male category is 52.9 percent at 2006 and remains relatively constant with a value of 51.5 percent at 2017; and the female category is 47.1 percent at 2006 and remains relatively constant with a value of 48.5 percent at 2017. — **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.

A line plot for distribution of candidates waiting for intestine transplant by race; the white category decreases by 10.9% from 65.2 percent at 2006 to 58.1 percent at 2017; the black category increases by 31.4% from 16.3 percent at 2006 to 21.4 percent at 2017; the hispanic category is 14.5 percent at 2006 and remains relatively constant with a value of 15.5 percent at 2017; the asian category is 2.6 percent at 2006 and remains relatively constant with a value of 2.6 percent at 2017; and the other/unknown category increases by 67.1% from 1.4 percent at 2006 to 2.4 percent at 2017. — **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.

A line plot for distribution of candidates waiting for intestine transplant by diagnosis; the necrotizing enterocolitis category is 11.5 percent at 2006 and remains relatively constant with a value of 10.8 percent at 2017; the congenital sgs category decreases by 12.3% from 20.9 percent at 2006 to 18.4 percent at 2017; the non to congenital sgs category increases by 12.9% from 29 percent at 2006 to 32.7 percent at 2017; the pseudo to obstruction category increases by 49.7% from 5 percent at 2006 to 7.5 percent at 2017; the enteropathies category decreases by 19.6% from 3.2 percent at 2006 to 2.6 percent at 2017; and the other/unknown category is 30.4 percent at 2006 and remains relatively constant with a value of 28 percent at 2017. — **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.

A line plot for distribution of candidates waiting for intestine transplant by waiting time; the less than 1 year category decreases by 38.3% from 72.4 percent at 2006 to 44.7 percent at 2017; the 1 to less than 2 category increases by 41.1% from 11.7 percent at 2006 to 16.5 percent at 2017; the 2 to less than 3 category increases by 70.5% from 4.8 percent at 2006 to 8.2 percent at 2017; the 3 to less than 4 category increases by 297.6% from 2 percent at 2006 to 8 percent at 2017; the 4 to less than 5 category increases by 75.4% from 2 percent at 2006 to 3.5 percent at 2017; and the greater than or equal to 5 category increases by 170.6% from 7 percent at 2006 to 19.1 percent at 2017. — **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.

A line plot for distribution of candidates waiting for intestine transplant by medical urgency; the status 1 category decreases by 19.9% from 73.4 percent at 2006 to 58.8 percent at 2017; the non to urgent category increases by 52.0% from 18.1 percent at 2006 to 27.5 percent at 2017; and the inactive category increases by 61.5% from 8.5 percent at 2006 to 13.6 percent at 2017. — **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.

A line plot for distribution of candidates waiting for intestine transplant by liver co-listing; the in category increases by 48.9% from 36.8 percent at 2006 to 54.8 percent at 2017; and the in to li category decreases by 28.5% from 63.2 percent at 2006 to 45.2 percent at 2017. — **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.

A line plot for deceased donor intestine transplant rates among waitlist candidates by age and liver co-listing; the in, age less than 18 category decreases by 46.4% from 70.3 transplants per 100 waitlist years at 2006 to 37.7 transplants per 100 waitlist years at 2017; the in, age greater than or equal to 18 category decreases by 55.5% from 39.4 transplants per 100 waitlist years at 2006 to 17.5 transplants per 100 waitlist years at 2017; the in to li, age less than 18 category decreases by 45.9% from 167.6 transplants per 100 waitlist years at 2006 to 90.7 transplants per 100 waitlist years at 2017; and the in to li, age greater than or equal to 18 category decreases by 58.1% from 145 transplants per 100 waitlist years at 2006 to 60.7 transplants per 100 waitlist years at 2017. — **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.

A line plot for three-year outcomes for candidates waiting for intestine transplant without liver, new listings in 2014; the still waiting category decreases by 77.1% from 100 percent at 0 Months postlisting to 22.9 percent at 36 Months postlisting; the removed from list category is 0 percent at 0 Months postlisting and is percent at 36 Months postlisting; the died category is 0 percent at 0 Months postlisting and is percent at 36 Months postlisting; and the dd transplant category is 0 percent at 0 Months postlisting and is percent at 36 Months postlisting. — **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.

A line plot for three-year outcomes for candidates waiting for intestine transplant with liver, new listings in 2014; the still waiting category decreases by 94.3% from 100 percent at 0 Months postlisting to 5.7 percent at 36 Months postlisting; the removed from list category is 0 percent at 0 Months postlisting and is percent at 36 Months postlisting; the died category is 0 percent at 0 Months postlisting and is percent at 36 Months postlisting; and the dd transplant category is 0 percent at 0 Months postlisting and is percent at 36 Months postlisting. — **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.

A line plot for median months to intestine transplant for waitlist candidates by age; the age less than 18,in category increases by 85.8% from 25.2 months at 2006-2007 to 46.9 months at 2014-2015; the age greater than or equal to 18,in category increases by 148.2% from 1.9 months at 2006-2007 to 4.7 months at 2016-2017; the age less than 18, in to li category is 8.1 months at 2006-2007 and remains relatively constant with a value of 8.2 months at 2016-2017; the age greater than or equal to 18, in to li category increases by 51.0% from 3.4 months at 2006-2007 to 5.2 months at 2016-2017; and the all category decreases by 10.6% from 6.8 months at 2006-2007 to 6.1 months at 2016-2017. — **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.

A line plot for pretransplant mortality rates among candidates waitlisted for intestine transplant by age; the less than 18 category decreases by 83.8% from 22.7 deaths per 100 waitlist years at 2006-2007 to 3.7 deaths per 100 waitlist years at 2016-2017; the greater than or equal to 18 category decreases by 75.6% from 32.4 deaths per 100 waitlist years at 2006-2007 to 7.9 deaths per 100 waitlist years at 2016-2017; and the all category decreases by 79.0% from 25 deaths per 100 waitlist years at 2006-2007 to 5.2 deaths per 100 waitlist years at 2016-2017. — **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.

A line plot for pretransplant mortality rates among candidates waitlisted for intestine transplant by race; the white category decreases by 76.0% from 27.4 deaths per 100 waitlist years at 2006-2007 to 6.6 deaths per 100 waitlist years at 2016-2017; the black category decreases by 76.4% from 18 deaths per 100 waitlist years at 2006-2007 to 4.2 deaths per 100 waitlist years at 2016-2017; and the hispanic category decreases by 83.1% from 21.6 deaths per 100 waitlist years at 2006-2007 to 3.7 deaths per 100 waitlist years at 2016-2017. — **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.

A line plot for pretransplant mortality rates among candidates waitlisted for intestine transplant by diagnosis; the necrotizing enterocolitis category decreases by 78.0% from 24.8 deaths per 100 waitlist years at 2006-2007 to 5.4 deaths per 100 waitlist years at 2016-2017; the congenital sgs category decreases by 79.5% from 24.6 deaths per 100 waitlist years at 2006-2007 to 5.1 deaths per 100 waitlist years at 2016-2017; the non to congential sgs category decreases by 69.7% from 27.7 deaths per 100 waitlist years at 2006-2007 to 8.4 deaths per 100 waitlist years at 2016-2017; and the other/unknown category decreases by 86.2% from 23.7 deaths per 100 waitlist years at 2006-2007 to 3.3 deaths per 100 waitlist years at 2016-2017. — **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.

A line plot for pretransplant mortality rates among candidates waitlisted for intestine transplant by liver co-listing; the in, age less than 18 category decreases by 79.1% from 38 deaths per 100 waitlist years at 2006-2007 to 7.9 deaths per 100 waitlist years at 2016-2017; the in, age greater than or equal to 18 category decreases by 62.7% from 5.1 deaths per 100 waitlist years at 2006-2007 to 1.9 deaths per 100 waitlist years at 2016-2017; the in to li, age less than 18 category decreases by 66.2% from 55.5 deaths per 100 waitlist years at 2006-2007 to 18.8 deaths per 100 waitlist years at 2016-2017; and the in to li, age greater than or equal to 18 category decreases by 75.9% from 19.5 deaths per 100 waitlist years at 2006-2007 to 4.7 deaths per 100 waitlist years at 2016-2017. — **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.

A line plot for deceased intestine donor count by age; the less than 5 category decreases by 56.0% from 84 count at 2006 to 37 count at 2017; the 5 to 17 category decreases by 32.6% from 43 count at 2006 to 29 count at 2017; the 18 to 34 category decreases by 18.6% from 43 count at 2006 to 35 count at 2017; and the greater than or equal to 35 category decreases by 21.4% from 14 count at 2006 to 11 count at 2017. — **Figure IN 18. Deceased intestine donor count by age**
Count of deceased donors whose intestines were recovered for transplant, by age at donation.

A line plot for distribution of deceased intestine donors by age; the less than 5 category decreases by 29.6% from 47.4 percent at 2006 to 33.3 percent at 2017; the 5 to 17 category increases by 14.8% from 23.4 percent at 2006 to 26.9 percent at 2017; the 18 to 34 category increases by 34.0% from 22.8 percent at 2006 to 30.6 percent at 2017; and the greater than or equal to 35 category increases by 43.9% from 6.4 percent at 2006 to 9.3 percent at 2017. — **Figure IN 19. Distribution of deceased intestine donors by age**
Deceased donors whose intestines were recovered for transplant.

A line plot for distribution of deceased intestine donors by race; the white category increases by 25.6% from 53.8 percent at 2006 to 67.6 percent at 2017; the black category decreases by 18.9% from 24 percent at 2006 to 19.4 percent at 2017; the hispanic category decreases by 50.2% from 20.5 percent at 2006 to 10.2 percent at 2017; and the other/unknown category increases by 58.3% from 1.8 percent at 2006 to 2.8 percent at 2017. — **Figure IN 20. Distribution of deceased intestine donors by race**
Deceased donors whose intestines were recovered for transplant.

A line plot for rates of intestines recovered for transplant and not transplanted by donor age; the less than 18 category decreases by 37.0% from 4 percent at 2006-2007 to 2.5 percent at 2016-2017; and the greater than or equal to 18 category decreases by 22.0% from 9.3 percent at 2006-2007 to 7.3 percent at 2016-2017. — **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.

A line plot for rates of intestines recovered for transplant and not transplanted by donor sex; the male category increases by 10.3% from 4.1 percent at 2006-2007 to 4.6 percent at 2016-2017; the female category decreases by 45.5% from 8.1 percent at 2006-2007 to 4.4 percent at 2016-2017; and the all category decreases by 20.3% from 5.6 percent at 2006-2007 to 4.5 percent at 2016-2017. — **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.

A line plot for rates of intestines recovered for transplant and not transplanted by donor race; the white category decreases by 26.7% from 6.3 percent at 2006-2007 to 4.6 percent at 2016-2017; the black category is 3.3 percent at 2006-2007 and remains relatively constant with a value of 3.3 percent at 2016-2017; and the other/unknown category is 6.4 percent at 2006-2007 and remains relatively constant with a value of 6.1 percent at 2016-2017. — **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.

A line plot for rates of intestines recovered for transplant and not transplanted, by donor risk of disease transmission; the phs increased risk category decreases by 12.5% from 14.3 percent at 2006-2007 to 12.5 percent at 2016-2017; and the not increased risk category decreases by 42.0% from 5.3 percent at 2006-2007 to 3.1 percent at 2016-2017. — **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.

A line plot for cause of death among deceased intestine donors; the anoxia category increases by 78.1% from 18.7 percent at 2006 to 33.3 percent at 2017; the cva/stroke category increases by 38.5% from 9.4 percent at 2006 to 13 percent at 2017; the head trauma category decreases by 24.3% from 67.3 percent at 2006 to 50.9 percent at 2017; the cns tumor category decreases by 100.0% from 0.6 percent at 2006 to 0 percent at 2017; and the other category decreases by 32.1% from 4.1 percent at 2006 to 2.8 percent at 2017. — **Figure IN 25. Cause of death among deceased intestine donors**
Deceased donors whose intestines were transplanted. CNS, central nervous system; CVA, cerebrovascular accident.

A line plot for total intestine transplants; the in category decreases by 26.8% from 71 transplants at 2006 to 52 transplants at 2017; the in to li category decreases by 45.2% from 104 transplants at 2006 to 57 transplants at 2017; and the all category decreases by 37.7% from 175 transplants at 2006 to 109 transplants at 2017. — **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.

A line plot for total intestine transplants by age; the less than 18 category decreases by 51.0% from 96 transplants at 2006 to 47 transplants at 2017; and the greater than or equal to 18 category decreases by 21.5% from 79 transplants at 2006 to 62 transplants at 2017. — **Figure IN 27. Total intestine transplants by age**
All intestine transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.

A line plot for total intestine transplants by sex; the male category decreases by 28.9% from 83 transplants at 2006 to 59 transplants at 2017; and the female category decreases by 45.7% from 92 transplants at 2006 to 50 transplants at 2017. — **Figure IN 28. Total intestine transplants by sex**
All intestine transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.

A line plot for total intestine transplants by race; the white category decreases by 39.7% from 121 transplants at 2006 to 73 transplants at 2017; the black category decreases by 24.0% from 25 transplants at 2006 to 19 transplants at 2017; and the other/unknown category decreases by 41.4% from 29 transplants at 2006 to 17 transplants at 2017. — **Figure IN 29. Total intestine transplants by race**
All intestine transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.

A line plot for total intestine transplants by diagnosis; the necrotizing enterocolitis category decreases by 42.1% from 19 transplants at 2006 to 11 transplants at 2017; the congenital sgs category decreases by 72.2% from 36 transplants at 2006 to 10 transplants at 2017; the non to congenital sgs category decreases by 20.6% from 68 transplants at 2006 to 54 transplants at 2017; the pseudo to obstruction category decreases by 50.0% from 14 transplants at 2006 to 7 transplants at 2017; the enteropathies category is 5 transplants at 2006 and remains relatively constant with a value of 5 transplants at 2017; and the other/unknown category decreases by 33.3% from 33 transplants at 2006 to 22 transplants at 2017. — **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.

A line plot for induction agent use in intestine transplant recipients; the il2 to ra category decreases by 29.1% from 19.8 percent at 2006 to 14 percent at 2017; the t to cell depleting category increases by 36.5% from 43.2 percent at 2006 to 59 percent at 2017; and the none category decreases by 31.5% from 43.8 percent at 2006 to 30 percent at 2017. — **Figure IN 31. Induction agent use in intestine transplant recipients**
Immunosuppression at transplant reported to the OPTN. IL2-RA, interleukin-2 receptor antagonist.

A line plot for immunosuppression regimen use in adult intestine transplant recipients; the tac mmf steroid category increases by 100.0% from 10 percent at 2006 to 20 percent at 2017; the tac mmf category increases by 80.0% from 6.7 percent at 2006 to 12 percent at 2017; the tac steroid category decreases by 16.2% from 52.5 percent at 2006 to 44 percent at 2017; the other category decreases by 35.1% from 30.8 percent at 2006 to 20 percent at 2017; and the none reported category is 0 percent at 2006 and is percent at 2017. — **Figure IN 32. Immunosuppression regimen use in adult intestine transplant recipients**
Immunosuppression regimen at transplant reported to the OPTN. Tac, tacrolimus. MMF, mycophenolate mofetil.

A bar plot for total hla a, b, and dr mismatches among adult deceased donor intestine transplant recipients, 2013-2017, the 0 group is 0.16 percent; the 1 group is 0.16 percent; the 2 group is 3.28 percent; the 3 group is 12.50 percent; the 4 group is 24.06 percent; the 5 group is 37.50 percent; the 6 group is 18.12 percent; and the unk. group is 4.22 percent. — **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.

A line plot for number of centers performing adult and pediatric and adult intestine transplants by center — **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.

A line plot for annual intestine transplant center volumes, by percentile; the 5th category is 1 transplants per center at 2006 and remains relatively constant with a value of 1 transplants per center at 2017; the 25th category is 1 transplants per center at 2006 and remains relatively constant with a value of 1 transplants per center at 2017; the median category decreases by 25.0% from 4 transplants per center at 2006 to 3 transplants per center at 2017; the 75th category decreases by 24.1% from 14.5 transplants per center at 2006 to 11 transplants per center at 2017; and the 95th category decreases by 35.5% from 31 transplants per center at 2006 to 20 transplants per center at 2017. — **Figure IN 35. Annual intestine transplant center volumes, by percentile**
Annual volume data include transplant recipients of any age.

A line plot for distribution of intestine transplants by annual center volume; the 1 to 2 category increases by 140.8% from 4.6 percent of transplants at 2006 to 11 percent of transplants at 2017; the 3 to 9 category increases by 48.2% from 14.9 percent of transplants at 2006 to 22 percent of transplants at 2017; and the greater than 10 category decreases by 16.9% from 80.6 percent of transplants at 2006 to 67 percent of transplants at 2017. — **Figure IN 36. Distribution of intestine transplants by annual center volume**
Based on annual volume data among recipients of any age.

A line plot for graft failure among transplant recipients of intestine without liver; the 6 to month category decreases by 41.5% from 21.7 percent at 1999-2000 to 12.7 percent at 2015-2016; the 1 to year category decreases by 21.7% from 24.7 percent at 1999-2000 to 19.4 percent at 2015-2016; the 3 to year category decreases by 20.8% from 49.3 percent at 1999-2000 to 39 percent at 2013-2014; the 5 to year category decreases by 10.6% from 58.5 percent at 1999-2000 to 52.3 percent at 2011-2012; and the 10 to year category is 64.7 percent at 1999-2000 and remains relatively constant with a value of 66.8 percent at 2007-2008. — **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.

A line plot for graft failure among transplant recipients of intestine with liver; the 6 to month category decreases by 35.5% from 35.1 percent at 1999-2000 to 22.7 percent at 2015-2016; the 1 to year category decreases by 28.0% from 37.3 percent at 1999-2000 to 26.8 percent at 2015-2016; the 3 to year category decreases by 19.5% from 45.9 percent at 1999-2000 to 36.9 percent at 2013-2014; the 5 to year category decreases by 23.2% from 54.7 percent at 1999-2000 to 42 percent at 2011-2012; and the 10 to year category decreases by 13.3% from 64.4 percent at 1999-2000 to 55.8 percent at 2007-2008. — **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.

A line plot for graft survival among intestine transplant recipients, 2010-2012, by age; the less than 18 category decreases by 42.1% from 100 percent at 0 Months post-transplant to 57.9 percent at 60 Months post-transplant; the greater than or equal to 18 category decreases by 56.5% from 100 percent at 0 Months post-transplant to 43.5 percent at 60 Months post-transplant; and the all category decreases by 50.1% from 100 percent at 0 Months post-transplant to 49.9 percent at 60 Months post-transplant. — **Figure IN 39. Graft survival among intestine transplant recipients, 2010-2012, by age**
Intestine graft survival estimated using unadjusted Kaplan-Meier methods.

A line plot for graft survival among adult deceased donor intestine transplant recipients, 2010-2012, by transplant type; the in category decreases by 53.5% from 100 percent at 0 Months post-transplant to 46.5 percent at 60 Months post-transplant; and the in to li category decreases by 44.8% from 100 percent at 0 Months post-transplant to 55.2 percent at 60 Months post-transplant. — **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.

A line plot for graft survival among adult deceased donor intestine transplant recipients, 2012, by metropolitan vs. non-metropolitan recipient residence; the metropolitan category decreases by 50.1% from 100 percent at 0 Months post-transplant to 49.9 percent at 60 Months post-transplant; and the non to metropolitan category decreases by 47.4% from 100 percent at 0 Months post-transplant to 52.6 percent at 60 Months post-transplant. — **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.

A line plot for graft survival among adult deceased donor intestine transplant recipients, 2012, by recipients — **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).

A line plot for recipients alive with a functioning intestine graft on june 30 of the year, by age at transplant and procedure; the age less than 18, in category increases by 58.9% from 107 patients at 2006 to 170 patients at 2017; the age greater than or equal to 18, in category increases by 123.5% from 149 patients at 2006 to 333 patients at 2017; the age less than 18, in to li category increases by 96.9% from 256 patients at 2006 to 504 patients at 2017; the age greater than or equal to 18, in to li category increases by 78.4% from 102 patients at 2006 to 182 patients at 2017; and the all category increases by 93.6% from 614 patients at 2006 to 1189 patients at 2017. — **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.

A bar plot for incidence of acute rejection by 1 year posttransplant among intestine transplant recipients by age and transplant type, 2015-2016, the age < 18, in group is 60.53 percent; the age >= 18, in group is 40.18 percent; the age < 18, in-li group is 46.75 percent; the age >= 18, in-li group is 31.15 percent; and the all group is 42.71 percent. — **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.

A bar plot for incidence of acute rejection by 1 year posttransplant among adult intestine transplant recipients by induction status, 2015-2016, the il2-ra group is 27.45 percent; the tcd group is 50.93 percent; and the no agents group is 35.56 percent. — **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.

A line plot for incidence of ptld among recipients of intestine transplant without liver by recipient ebv status at transplant, 2005-2015; the ebv to category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant; the ebv+ category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant; the ebv unknown category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant; and the all category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant. — **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.

A line plot for incidence of ptld among recipients of intestine transplant with liver by recipient ebv status at transplant, 2005-2015; the ebv to category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant; the ebv+ category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant; the ebv unknown category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant; and the all category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant. — **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.

A line plot for patient survival among adult deceased donor intestine transplant recipients, 2010-2012, by age and transplant type; the age less than 18, in category decreases by 24.6% from 100 percent at 0 Months post-transplant to 75.4 percent at 60 Months post-transplant; the age greater than or equal to 18, in category decreases by 39.4% from 100 percent at 0 Months post-transplant to 60.6 percent at 60 Months post-transplant; the age less than 18, in to li category decreases by 28.9% from 100 percent at 0 Months post-transplant to 71.1 percent at 60 Months post-transplant; and the age greater than or equal to 18, in to li category decreases by 57.4% from 100 percent at 0 Months post-transplant to 42.6 percent at 60 Months post-transplant. — **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%