The results of intestinal transplantation (ITx) have improved over the last decade. Adult and pediatric ITx was first initiated at our center in November 2003. We retrospectively reviewed our experience with ITx. Primary immunosuppression consisted of IL-2 receptor blockade induction with maintenance steroids, Tacrolimus, and Sirolimus. Sensitized recipients or recipients with a positive cytotoxic crossmatch received Thymoglobulin induction.

272 ITx have been performed in 263 patients from November 2003 to November 2016. 17 were retransplants, 8 were retransplants with the primary transplant at another center. Overall average age is 23.0 ± 21.3 years. 134 (49.3%) pediatric (<18 yrs), average age 3.42 ± 3.87 yrs (range 3 months – 17 yrs) and 138(50.7%) adult, average age 42.04 ± 12.0 yrs (range 18 – 66 yrs).

Grafts comprised of 155 isolated intestines (iITx), 69 liver-intestine (LI), 41 multivisceral (MVTx), and 7 modified multivisceral (mMVTx) transplants. 156 recipients received an en-bloc colon graft and 8 received a concomitant kidney graft. Most common indication in pediatric recipients were Gastroschisis (26), NEC (25), pseudoobstruction/motility (15), and volvulus (15). Adult indications were Pseudoobstruction/Motility (24), Mesenteric ischemia (19), and Inflammatory Bowel Disease (13).

Overall 1 and 3 year patient survival are 85.2 % and 70.4 % respectively. 1 year isolated ITx, Liver-Intestine, modified MVTx and MVTx patient survival were 88.7%, 91.1%, 85.7% and 61.4%. Overall pediatric 1 year patient survival was 88.5% and adult 1 year patient survival was 81.9% (p=0.133). 1 year retransplant (n=17) patient survival was not significantly lower: 76.5% vs. 85.8% (p=0.32).

Overall 1 year freedom from rejection (FFR) was 76.0%. FFR in adult and pediatric recipients was 67.2% and 85.5% respectively (p = 0.0005). Liver inclusive grafts had a higher 1 year FFR at 85.2 % vs 70.1 % (p =0.007). Dividing up our center experience volume in exactly half, the 1 year survival in the first half (n= 136 cases) was 81.5% and the second half 89.2% (p= 0.09).

This data reflects a cumulative experience of ITx at a large single institution with an extensive pediatric and adult ITx experience. 1 year patient survival has shown a tendency for improved results in the latter half of our experience.