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OPTN/SRTR 2021 Annual Data Report: Intestine

OPTN/SRTR 2021 Annual Data Report: Intestine

Simon P. Horslen1,2, Nicholas L. Wood1, Matthew Cafarella3, Erin M. Schnellinger3

1Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN

2Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA

3Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA

Abstract

There has been just over 30 years of experience in clinical intestine transplant. A rise in demand until 2007 with improving transplant outcomes preceded a subsequent fall in demand due, at least in part, to improvements in pretransplant care of patients with intestinal failure. Over the past 10 to 12 years, there has been no suggestion of an increase in demand and, particularly for adult transplant, there may be a continued trend toward fewer additions to the waiting list and fewer transplants, especially in those needing combined intestine-liver transplant. In addition, over the same period there has been no noticeable improvement in graft survival, with 1- and 5-year graft failure rates averaging 21.6% and 52.5%, respectively, for intestine-alone transplants and 28.6% and 47.2%, respectively, for combined intestine-liver allografts.

Keywords: Intestinal failure, intestine transplant, intestine-liver transplant, waiting list

1 INTRODUCTION

Intestine transplant remains the least common form of solid organ transplant and one of the most challenging. Despite 30 years of clinical experience, long-term outcomes for grafts and patients are considerably lower than those for other major organ transplants, with the possible exception of lung transplant, but intestine transplant has been demonstrated to be lifesaving and to improve quality of life for very many patients. The number of intestines transplanted per year peaked in 2007 and has declined since then. Initially this was most marked for pediatric populations with intestinal failure, because of improved intestinal rehabilitation; however, over the past few years, pediatric intestine transplant rates have plateaued. For the past decade, numbers of intestine transplants for adults have exceeded those for children, but adult intestine transplant rates have been falling, and this is most notable for those in need of combined intestine-liver transplant. A potential reason for this decrease may be due to changes in liver allocation policy and the 10% model for end-stage liver disease (MELD) increase afforded to adult patients requiring combined intestine-liver transplant, an increase which may no longer provide these patients sufficient priority.

There is much discussion regarding excessive nonuse rates for other organs, but for intestine there were 97 intestines procured for transplant in 2021 and 96 transplants carried out. It will be important to continue to monitor this trend, as more organ offers are needed to serve these candidates who often have very long waiting times once placed on the waitlist.

Another concern is how the COVID-19 pandemic may have influenced intestine transplant activity. With the small increases in waitlist additions, overall intestine transplant rates, and overall intestine transplants undertaken in 2020 and 2021 compared with those done in 2019, and no change in pretransplant mortality rates, it may be fair, albeit on the basis of limited nongranular data, to suggest that the overall effect of COVID-19 on intestine transplant activity in the United States has been negligible.

If we look at equity in intestine waiting lists and transplant numbers, understanding that these limited data do not tell the full story, there are no glaring differences in waitlist and transplant proportions based on race and ethnicity compared with the overall US population. Information on the waiting list, transplants, and outcomes is presented for intestine transplants either alone or in combination with liver. Both types include multivisceral transplants distinguished by inclusion or exclusion of liver.

2 WAITING LIST

Waitlist additions were similar in total to the previous year (144 in 2020 and 143 in 2021), although with 239 waitlist additions in 2010, the trend over 12 years is clearly toward fewer listings (Figure IN 1). This trend is also reflected in the number of prevalent patients awaiting intestine transplant: 466 candidates in 2010 (225 for intestine alone and 241 for combined intestine and liver) compared with 364 candidates waiting in 2021 (180 and 184 for isolated intestine and combined intestine and liver, respectively) (Figure IN 2). Over the preceding decade, there has been a gradual increase in the number of adults waiting for intestine transplant compared with candidates younger than 18 years, and in 2021 the adult numbers surpassed those of pediatric candidates for the first time ever with 56% of the waiting list aged 18 years or older (Figure IN 3). The racial and ethnic mix of the waiting list has been relatively consistent since 2010, with White patients making up between 59% and 64% of the list; Black patients, 15% to 21%; Hispanic patients, 14% to 18%; and Asian patients, 2% to 4% (Figure IN 5). Purely for reference, the US population in 2020 was 59.7% White, 12.6% Black, 18.6% Hispanic, and 5.9% Asian.1 The most common etiology of intestinal failure on the waiting list remained short-gut syndrome (SGS; 47%), which encompasses both congenital and noncongenital SGS, as well as necrotizing enterocolitis and probably a significant number in the other/unknown group (Figure IN 6). Enteropathies and intestinal pseudo-obstruction syndromes are rare and account for only about 10% of all indications for listing for intestine transplant (Figure IN 6).

Table IN 1 shows the demographic characteristics of intestine transplant candidates by whether they are simultaneously awaiting a liver transplant. Generally, these characteristics are similar between the two cohorts, although it appears that listing for combined intestine and liver is more common in male candidates and older patients. Candidates, in the main, come from metropolitan areas either close to the transplant center or from distances greater than 150 miles, presumably other metropolitan centers without an intestine transplant program. Medical characteristics of the two groups are shown in Table IN 2, and other than individuals with chronic intestinal pseudo-obstruction who were more likely to be listed for isolated intestine, other diagnostic groups were equally likely to be listed for isolated intestine and combined intestine-liver transplant. Major ABO blood groups were equally represented between intestine alone and combined intestine and liver, and approximately in line with the average distribution of blood groups in the US population.

The proportion of candidates with waiting times fewer than 90 days has increased in the past 2 years but remains lower than in 2010 (20.3% waiting fewer than 90 days in 2021 compared with 31.1% in 2010), and the trend for those waiting more than 2 years appears to be toward greater numbers (36.5% waiting more than 2 years in 2021 compared with 27.5% in 2010) (Figure IN 7). Transplant rates have risen over the past 2 years from the nadir in 2019 of 34.8 transplants per 100 patient-years to 44.9 transplants per 100 patient-years in 2021, suggesting that maybe the COVID-19 restrictions did not prevent intestine transplants from happening; but, again, this rate is lower than that seen in 2010 of 60.3 transplants per 100 patient-years (Figure IN 9). Transplant rates for children and adolescents have been fairly stable during the 12-year period (range, 20-35 transplants per 100 patient-years), whereas those for adults have varied widely from year to year (range, 60-130 transplants per 100 patient-years) (Figure IN 10). Transplant rates are not clearly different by race and ethnicity (Figure IN 11), nor among candidates awaiting either isolated intestine or combined intestine-liver transplant (Figure IN 12).

In 2021, 88 candidates were removed from the isolated intestine waiting list: 57 (64.8%) underwent deceased donor transplant, 3 (3.4%) died, 16 (18.2%) were removed from the list because their condition improved, and 11 (12.5%) were removed for other, unspecified reasons (Table IN 5). Outcomes at 3 years for newly listed candidates for isolated intestine transplant in 2016 through 2018 show that 67.4% underwent deceased donor transplant, 3.8% died, 14.2% were removed from the list, and 14.6% were still waiting 3 years after listing (Figure IN 13). Likewise, 75 candidates were removed from the intestine-liver waiting list in 2021: 38 (50.7%) underwent deceased donor transplant, 12 (16.0%) died, 7 (9.3%) were removed from the list because their condition improved, and 10 (13.3%) were considered too sick to undergo transplant (Table IN 5). Of intestine-liver candidates listed from 2016 through 2018, 67.8% underwent deceased donor transplant within 3 years, 11.4% were removed from the list, 10.2% died, and 10.6% were still waiting (Figure IN 14).

The overall pretransplant mortality for intestinal transplant candidates has ranged from 6 to 12 deaths per 100 patient-years since 2010 (Figure IN 15), and rates vary by age. Pretransplant mortality is higher for adult candidates, ranging from 9.6 deaths per 100 patient-years in 2017 to 24.5 deaths per 100 patient-years in 2014. For pediatric candidates, the range was from a low of 2.0 deaths per 100 patient-years in 2020 up to 5.4 deaths per 100 patient-years in 2012 (Figure IN 16). Noticeably, there was no increase in pretransplant mortality seen with the appearance of COVID-19. Pretransplant mortality in 2021 was, as has always been seen previously, higher for combined intestine-liver (14.1 deaths per 100 patient-years) than for isolated intestine transplant candidates (2.8 deaths per 100 patient-years) (Figure IN 19).

3 DONATION

In 2021, 97 intestines were recovered from deceased donors (Figure IN 21). The greatest proportion of intestine donors in 2021 were aged younger than 18 years (56.7%) (Figure IN 23). Most intestine donors were White (60.8%) (Figure IN 25). The overall rate of intestines recovered for transplant and not transplanted was only 1% in 2021 (Figure IN 26). The most common cause of death among deceased intestine donors has historically always been head trauma, and this was again the case in 2021 with 56.7% of deceased intestine donors being as the result of head injury, although in 2020 there was a clear increase in the proportion of donors who died of anoxia (Figure IN 28).

4 TRANSPLANT

The lowest number of intestine transplants done in any 1 year since 2010 was 81 in 2019 (Figure IN 29). An increase in transplant activity has been seen in the past 2 years, with 91 intestine transplants performed in 2020 and 96 in 2021. Of the 96 transplants done in the past year, 58 were intestine alone and 38 were liver-inclusive transplants (Figure IN 30).

Pediatric recipients of intestine transplants outnumbered adult recipients for at least the first 20 years of intestine transplantation, but since the late 2000s the number of intestine transplant recipients older than 18 years has overtaken that of recipients who are children or adolescents. Pediatric recipient counts declined from 62 in 2010 to a low of 32 in 2019, with only a slight rebound to 36 in 2021; adult recipient counts fell from 89 in 2010 to 60 in 2021 (Figure IN 31). In 2021, a little more than half of intestine-liver recipients were aged younger than 18 years (55.3% vs 25.9% of intestine-alone recipients) (Table IN 6). Most recipients had private insurance and resided in metropolitan areas (Table IN 6). Short-gut syndrome was the main cause of disease leading to both intestine and intestine-liver transplant (Table IN 7).

Most recipients of an intestine-containing allograft in 2021 waited less than a year from listing to their transplant: 75.8% of isolated intestine recipients and 65.8% of intestine-liver recipients (Table IN 8).

5 IMMUNOSUPPRESSION

The use of induction immunosuppression with antithymocyte globulin or interleukin 2 receptor blocking antibody is common in intestine transplant and was used in almost 80% of cases in 2021 (Figure IN 35). Tacrolimus remains the mainstay for maintenance immunosuppression, used mainly in combination with corticosteroids or mycophenolate mofetil or both (Figure IN 36). There also appears to be a decrease in the use of steroid-free regimens, although Figure IN 36 only specifies the combination of tacrolimus and mycophenolate agents without steroids, which was used in almost 30% of cases in 2012 and less than 10% in 2021.

6 OUTCOMES

There has been no noticeable change in graft survival at any time point after intestine transplant (with or without liver) across the period from 2010 through 2021 (Figure IN 37 and Figure IN 38). Graft survival at 5 years for the cohort who underwent transplant in the period 2014 through 2016 is better for those who underwent transplant at a younger age, with recipients younger than 18 years having a 62% graft survival at 5 years compared with adults having 43% survival (Figure IN 39). Graft survival for this same cohort based on whether the allograft contained the liver is essentially similar (Figure IN 40), as is the outcome for residence in a metropolitan versus non-metropolitan area (Figure IN 41).

Patient survival for the 2014-2016 cohort based on whether a patient received the liver along with the intestine shows better survival short term for intestine-alone recipients (1-year patient survival 86.4% for isolated intestine recipients vs 75.2% for recipients of combined intestine and liver), but this difference narrowed considerably by 5 years (61.2% vs 58.1%, respectively) (Figure IN 46).

REFERENCES

1.
Our changing population: United states. USAFacts. Accessed September 22, 2022. https://usafacts.org/data/topics/people-society/population-and-demographics/our-changing-population.




This publication was produced for the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), by Hennepin Healthcare Research Institute (HHRI) and the United Network for Organ Sharing (UNOS) under contracts HHSH75R60220C00011 and HHSH250201900001C, respectively.

This publication lists nonfederal resources in order to provide additional information to consumers. The views and content in these resources have not been formally approved by HHS or HRSA. Neither HHS nor HRSA endorses the products or services of the listed resources.

The OPTN/SRTR 2021 Annual Data Report is not copyrighted. Readers are free to duplicate and use all or part of the information contained in this publication. Data are not copyrighted and may be used without permission if appropriate citation information is provided.

Pursuant to 42 U.S.C. 1320b-10, this publication may not be reproduced, reprinted, or redistributed for a fee without specific written authorization from HHS.

Suggested Citations:
Full citation: Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR). OPTN/SRTR 2021 Annual Data Report. U.S. Department of Health and Human Services, Health Resources and Services Administration; 2023. Accessed [insert date]. http://srtr.transplant.hrsa.gov/annual_reports/Default.aspx
Abbreviated citation: OPTN/SRTR 2021 Annual Data Report. HHS/HRSA; 2023. Accessed [insert date]. http://srtr.transplant.hrsa.gov/annual_reports/Default.aspx

Publications based on data in this report or supplied on request must include a citation and the following statement: The data and analyses reported in the OPTN/SRTR 2021 Annual Data Report have been supplied by the United Network for Organ Sharing and Hennepin Healthcare Research Institute under contract with HHS/HRSA. The authors alone are responsible for reporting and interpreting these data; the views expressed herein are those of the authors and not necessarily those of the U.S. government.

This report is available at https://srtr.transplant.hrsa.gov. Individual chapters may be downloaded.

List of Figures

List of Tables




**New candidates added to the intestine transplant waiting list by liver colisting.** 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. Active and inactive patients are included. Candidates listed at more than one center are counted once per listing. New intestine-liver candidates are those listed for both organs on the same day.

Figure IN 1: New candidates added to the intestine transplant waiting list by liver colisting. 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. Active and inactive patients are included. Candidates listed at more than one center are counted once per listing. New intestine-liver candidates are those listed for both organs on the same day.




**All candidates on the intestine transplant waiting list by liver colisting.** Candidates on the list at any time during the year. Candidates listed at more than one center are counted once per listing.

Figure IN 2: All candidates on the intestine transplant waiting list by liver colisting. Candidates on the list at any time during the year. Candidates listed at more than one center are counted once per listing.




**Distribution of candidates waiting for intestine transplant by age.** Candidates waiting for transplant at any time in the given year. Active and inactive candidates are included. Candidates listed at more than one center are counted once per listing. Age is determined at the earliest of transplant, death, removal, or December 31 of the year.

Figure IN 3: Distribution of candidates waiting for intestine transplant by age. Candidates waiting for transplant at any time in the given year. Active and inactive candidates are included. Candidates listed at more than one center are counted once per listing. Age is determined at the earliest of transplant, death, removal, or December 31 of the year.




**Distribution of candidates waiting for intestine transplant by sex.** Candidates waiting for transplant at any time in the given year. Active and inactive patients are included. Candidates listed at more than one center are counted once per listing.

Figure IN 4: Distribution of candidates waiting for intestine transplant by sex. Candidates waiting for transplant at any time in the given year. Active and inactive patients are included. Candidates listed at more than one center are counted once per listing.




**Distribution of candidates waiting for intestine transplant by race.** Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. 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 at more than one center are counted once per listing. Active and inactive patients are included.




**Distribution of candidates waiting for intestine transplant by diagnosis.** Candidates waiting for transplant at any time in the given year. Active and inactive patients are included. Candidates listed at more than one center are counted once per listing.

Figure IN 6: Distribution of candidates waiting for intestine transplant by diagnosis. Candidates waiting for transplant at any time in the given year. Active and inactive patients are included. Candidates listed at more than one center are counted once per listing.




**Distribution of candidates waiting for intestine transplant by waiting time.** Candidates waiting for transplant at any time in the given year. Time on the waiting list is determined at the earliest of transplant, death, removal, or December 31 of the year. Active and inactive candidates are included. Candidates listed at more than one center are counted once per listing.

Figure IN 7: Distribution of candidates waiting for intestine transplant by waiting time. Candidates waiting for transplant at any time in the given year. Time on the waiting list is determined at the earliest of transplant, death, removal, or December 31 of the year. Active and inactive candidates are included. Candidates listed at more than one center are counted once per listing.




**Distribution of candidates waiting for intestine transplant by liver colisting.** Candidates waiting for transplant at any time in the given year. Intestine-liver candidates were dually listed on at least one day during the year. Active and inactive patients are included. Candidates listed at more than one center are counted once per listing.

Figure IN 8: Distribution of candidates waiting for intestine transplant by liver colisting. Candidates waiting for transplant at any time in the given year. Intestine-liver candidates were dually listed on at least one day during the year. Active and inactive patients are included. Candidates listed at more than one center are counted once per listing.




**Overall donor intestine transplant rates among waitlist candidates.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately.

Figure IN 9: Overall donor intestine transplant rates among waitlist candidates. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately.




**Deceased donor intestine transplant rates among waitlist candidates by age.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year.

Figure IN 10: Deceased donor intestine transplant rates among waitlist candidates by age. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year.




**Deceased donor intestine transplant rates among waitlist candidates by race.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately.

Figure IN 11: Deceased donor intestine transplant rates among waitlist candidates by race. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately.




**Deceased donor intestine transplant rates among waitlisted adult candidates by liver colisting.** 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 colisting is determined at the time of listing.

Figure IN 12: Deceased donor intestine transplant rates among waitlisted adult candidates by liver colisting. 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 colisting is determined at the time of listing.




**Three-year outcomes for candidates waiting for intestine transplant without liver, new listings in 2016-2018.** Candidates listed at more than one center are counted once per listing. Removed from list includes all reasons except transplant and death. DD, deceased donor.

Figure IN 13: Three-year outcomes for candidates waiting for intestine transplant without liver, new listings in 2016-2018. Candidates listed at more than one center are counted once per listing. Removed from list includes all reasons except transplant and death. DD, deceased donor.




**Three-year outcomes for candidates waiting for intestine transplant with liver, new listings in 2016-2018.** Candidates listed at more than one center are counted once per listing. Removed from list includes all reasons except transplant and death. DD, deceased donor.

Figure IN 14: Three-year outcomes for candidates waiting for intestine transplant with liver, new listings in 2016-2018. Candidates listed at more than one center are counted once per listing. Removed from list includes all reasons except transplant and death. DD, deceased donor.




**Overall pretransplant mortality rates among candidates waitlisted for intestine transplant.** 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. Candidates listed at more than one center are counted once per listing.

Figure IN 15: Overall pretransplant mortality rates among candidates waitlisted for intestine transplant. 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. Candidates listed at more than one center are counted once per listing.




**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. Candidates listed at more than one center are counted once per listing. Age is determined at the later of listing date or January 1 of the given year.

Figure IN 16: 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. Candidates listed at more than one center are counted once per listing. Age is determined at the later of listing date or January 1 of the given year.




**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. Candidates listed at more than one center are counted once per listing.

Figure IN 17: 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. Candidates listed at more than one center are counted once per listing.




**Pretransplant mortality rates among candidates waitlisted for intestine transplant by sex.** 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. Candidates listed at more than one center are counted once per listing.

Figure IN 18: Pretransplant mortality rates among candidates waitlisted for intestine transplant by sex. 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. Candidates listed at more than one center are counted once per listing.




**Pretransplant mortality rates among candidates waitlisted for intestine transplant by liver colisting.** 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. Candidates listed at more than one center are counted once per listing. Intestine-liver colisting is determined at the later of listing date and January 1 of the year.

Figure IN 19: Pretransplant mortality rates among candidates waitlisted for intestine transplant by liver colisting. 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. Candidates listed at more than one center are counted once per listing. Intestine-liver colisting is determined at the later of listing date and January 1 of the year.




**Overall deaths within six months after removal among intestine waitlist candidates.** Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.

Figure IN 20: Overall deaths within six months after removal among intestine waitlist candidates. Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.




**Overall deceased intestine donor count.** Count of deceased donors whose intestines were recovered for transplant.

Figure IN 21: Overall deceased intestine donor count. Count of deceased donors whose intestines were recovered for transplant.




**Deceased intestine donor count by age.** Count of deceased donors whose intestines were recovered for transplant.

Figure IN 22: Deceased intestine donor count by age. Count of deceased donors whose intestines were recovered for transplant.




**Distribution of deceased intestine donors by age.** Deceased donors whose intestines were recovered for transplant.

Figure IN 23: Distribution of deceased intestine donors by age. Deceased donors whose intestines were recovered for transplant.




**Distribution of deceased intestine donors by sex.** Deceased donors whose intestines were recovered for transplant.

Figure IN 24: Distribution of deceased intestine donors by sex. Deceased donors whose intestines were recovered for transplant.




**Distribution of deceased intestine donors by race.** Deceased donors whose intestines were recovered for transplant.

Figure IN 25: Distribution of deceased intestine donors by race. Deceased donors whose intestines were recovered for transplant.




**Overall percent of intestines recovered for transplant and not transplanted.** Percentages of intestines not transplanted out of all intestines recovered for transplant.

Figure IN 26: Overall percent of intestines recovered for transplant and not transplanted. Percentages of intestines not transplanted out of all intestines recovered for transplant.




**Percent 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 27: Percent of intestines recovered for transplant and not transplanted by donor sex. Percentages of intestines not transplanted out of all intestines recovered for transplant.




**Cause of death among deceased intestine donors.** Deceased donors whose intestines were transplanted. CVA, cerebrovascular accident.

Figure IN 28: Cause of death among deceased intestine donors. Deceased donors whose intestines were transplanted. CVA, cerebrovascular accident.




**Overall intestine transplants.** All intestine transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.

Figure IN 29: Overall intestine transplants. All intestine transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.




**Total intestine transplants by transplant type.** All intestine transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.

Figure IN 30: Total intestine transplants by transplant type. All intestine transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.




**Total intestine transplants by age.** All intestine transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.

Figure IN 31: Total intestine transplants by age. All intestine transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.




**Total intestine transplants by sex.** All intestine transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.

Figure IN 32: Total intestine transplants by sex. All intestine transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.




**Total intestine transplants by race.** All intestine transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.

Figure IN 33: Total intestine transplants by race. All intestine transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.




**Total intestine transplants by diagnosis.** All intestine transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients. SGS, short-gut syndrome.

Figure IN 34: Total intestine transplants by diagnosis. All intestine transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients. SGS, short-gut syndrome.




**Induction agent use in intestine transplant recipients.** Immunosuppression at transplant reported to the OPTN.

Figure IN 35: Induction agent use in intestine transplant recipients. Immunosuppression at transplant reported to the OPTN.




**Distribution of immunosuppression regimen use in intestine transplant recipients.** Immunosuppression regimen at transplant reported to the OPTN. Tac, tacrolimus. MMF, all mycophenolate agents.

Figure IN 36: Distribution of immunosuppression regimen use in intestine transplant recipients. Immunosuppression regimen at transplant reported to the OPTN. Tac, tacrolimus. MMF, all mycophenolate agents.




**Graft failure among transplant recipients of intestine without liver.** All recipients of deceased donor intestines, including multiorgan transplants.

Figure IN 37: Graft failure among transplant recipients of intestine without liver. All recipients of deceased donor intestines, including multiorgan transplants.




**Graft failure among transplant recipients of intestine with liver.** All recipients of deceased donor intestines, including multiorgan transplants.

Figure IN 38: Graft failure among transplant recipients of intestine with liver. All recipients of deceased donor intestines, including multiorgan transplants.




**Graft survival among deceased donor intestine transplant recipients, 2014-2016, by age.** Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure IN 39: Graft survival among deceased donor intestine transplant recipients, 2014-2016, by age. Graft survival estimated using unadjusted Kaplan-Meier methods.




**Graft survival among deceased donor intestine transplant recipients, 2014-2016, by transplant type.** Intestine graft survival estimated using unadjusted Kaplan-Meier methods.

Figure IN 40: Graft survival among deceased donor intestine transplant recipients, 2014-2016, by transplant type. Intestine graft survival estimated using unadjusted Kaplan-Meier methods.




**Graft survival among deceased donor intestine transplant recipients, 2014-2016, by metropolitan vs. non-metropolitan recipient residence.** Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure IN 41: Graft survival among deceased donor intestine transplant recipients, 2014-2016, by metropolitan vs. non-metropolitan recipient residence. Graft survival estimated using unadjusted Kaplan-Meier methods.




**Incidence of acute rejection by 1 year posttransplant among adult intestine transplant recipients by age.** Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method.

Figure IN 42: Incidence of acute rejection by 1 year posttransplant among adult intestine transplant recipients by age. Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method.




**Incidence of acute rejection by 1 year posttransplant among adult intestine transplant recipients by induction agent.** Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method. IL2Ab, interleukin-2 receptor antibody; TCD, T-cell depleting.

Figure IN 43: Incidence of acute rejection by 1 year posttransplant among adult intestine transplant recipients by induction agent. Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method. IL2Ab, interleukin-2 receptor antibody; TCD, T-cell depleting.




**Incidence of PTLD among recipients of intestine transplant without liver by recipient EBV status at transplant, 2010-2016.** Cumulative incidence is estimated using the Kaplan-Meier 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's disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus; PTLD, posttransplant lymphoproliferative disorder.

Figure IN 44: Incidence of PTLD among recipients of intestine transplant without liver by recipient EBV status at transplant, 2010-2016. Cumulative incidence is estimated using the Kaplan-Meier 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’s disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus; PTLD, posttransplant lymphoproliferative disorder.




**Incidence of PTLD among recipients of intestine transplant with liver by recipient EBV status at transplant, 2010-2016.** Cumulative incidence is estimated using the Kaplan-Meier 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's disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus; PTLD, posttransplant lymphoproliferative disorder.

Figure IN 45: Incidence of PTLD among recipients of intestine transplant with liver by recipient EBV status at transplant, 2010-2016. Cumulative incidence is estimated using the Kaplan-Meier 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’s disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus; PTLD, posttransplant lymphoproliferative disorder.




**Patient survival among deceased donor intestine transplant recipients, 2014-2016, by transplant type.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure IN 46: Patient survival among deceased donor intestine transplant recipients, 2014-2016, by transplant type. Patient survival estimated using unadjusted Kaplan-Meier methods.