Intestinal Retransplantation: Analysis of Organ Procurement and Transplantation Network Database

Background. We evaluated the outcomes of intestinal retransplantation in children and adults in the United States. Methods. The United Network for Organ Sharing data were analyzed from October 1987 to August 2009. Results. In adult isolated intestinal transplant (ITx) retransplants (n = 41), patient survival was 80.1%, 47.4%, and 28.5% at 1, 3, and 5 years, which was worse than primary isolated ITx (P = 0.005). For liver ITx (L-ITx) retransplants (n = 31), patient survival was 63.1%, 56.1%, and 46.8% and was not significantly different than primary L-ITx. In pediatric isolated ITx retransplants (n = 28), patient survival at 1, 3, and 5 years was 80.7%, 74%, and 57.5%; graft survival was 76.4%, 56.6%, and 44%. In L-ITx retransplants (n = 49), patient survival was 42%, 42%, and 42%; graft survival was 39%, 39%, and 39%. Patient and graft survival in adult L-ITx retransplants were better in era 2 (January 2001-August 2009) than era 1 (October 1987-December 2000) (P = 0.01). Among pediatric L-ITx retransplants, outcomes were worst in children younger than 2 years (n = 12). In regression analysis, prior hospitalization was a negative predictor for all the groups of patients (relative risk, 5.4). Conclusion. Patient and graft survival in adult isolated ITx are less favorable after a retransplant compared with a primary transplant. Patient and graft survival are also poor in pediatric L-ITx after a retransplant, especially for children younger than 2 years of age. L-ITx retransplant results improved significantly in era 2 in adult recipients.