P289a Intestinal transplantation for Crohns Disease: A 5-year nationwide follow-up
B. Limketkai1, B. Orandi2, X. Luo2, D. Segev2, J.-F. Colombel*3
1Stanford University School of Medicine, Division of Gastroenterology & Hepatology, Stanford, California, United States, 2Johns Hopkins University School of Medicine, Department of Surgery, Baltimore, Maryland, United States, 3Icahn School of Medicine at Mount Sinai, Division of Gastroenterology, New York, New York, United States
Crohn’s disease (CD) is a chronic and progressive inflammatory bowel disease. Despite advances in medical therapy, half of patients still require bowel resection 10 years after diagnosis, and a third will require at least another resection within the next 10 years. A progressive reduction in small bowel length may lead to short gut syndrome and need for long-term total parenteral nutrition (TPN). Intestinal transplantation (ITxp) may benefit these patients who develop TPN-associated liver failure, loss of vascular access, and recurrent catheter-associated sepsis. However, published data on post-transplant outcomes are sparse and limited to small groups of patients. Our primary aim is to characterise long-term risk of rejection, graft failure, and death among CD patients in the largest available ITxp cohort in the United States.
Characteristics of patients undergoing intestinal transplantation for Crohn’s disease and other indications.
|Crohn’s Disease (N=134)||Other Indications (N=935)||P Value|
|Age at transplantation (SD)||44.7 (9.8)||40.2 (13.4)||<0.01|
|Male (%)||63 (47.0)||440 (47.1)||0.99|
|Race, Caucasian (%)||129 (96.3)||821 (87.8)||<0.01|
|Body mass index (%)||0.03|
|- Underweight||17 (12.7)||143 (15.3)|
|- Overweight or obese||28 (20.9)||251 (26.9)|
|Waitlist time, < 6 months (%)||103 (76.8)||735 (78.7)||0.81|
|Deceased donor (%)||132 (98.5)||917 (98.1)||0.53|
The study included all adults who underwent ITxp between May 1990 and November 2013, as recorded in the U.S. Scientific Registry of Transplant Recipients. Data were collected on patient demographics, body mass index (BMI), waitlist time, and transplant indications. Outcomes included allograft rejection, graft failure, TPN resumption, and survival. Cox proportional hazards analyses were used to evaluate time to events, comparing CD with non-CD ITxp patients. Multivariable analyses were adjusted for age at transplantation, sex, race, BMI, and time on waitlist.
There were 976 adults who underwent 1069 ITxp from 1990 through 2013; 134 (12.5%) were for CD (Table). Patients were followed for a median of 36 months and a maximum of 60. At transplantation, CD patients had a mean age of 44.7 years, mostly normal or overweight BMI (73.9%), and <6 months on the waitlist (76.8%). Actuarial risk of acute rejection was 22.4% at 1 year, 38.1% at 3 years, and 42.7% at 5 years, while risk of graft failure was lower at 5.6%, 16.8%, and 19.2%, respectively. Patient survival was 69.2%, 62.0%, and 62.0% at 1, 3, and 5 years, respectively. In multivariable analyses, CD patients had a similar risk of acute rejection (hazard ratio [HR] 0.85; 95% confidence interval [CI] 0.59-1.24; P=0.40), graft failure (HR 1.70; 95% CI 0.91-3.17; P=0.09), resumption of TPN (HR 1.48; 95% CI 0.93-2.35; P=0.10), and death (HR 1.07; 95% CI 0.70-1.64; P=0.77) as non-CD patients.
In the largest reported cohort of CD patients undergoing intestinal transplantation, long-term outcomes were similar for CD and non-CD indications. Intestinal transplantation should be considered for CD patients with intestinal failure.