Objectives: The purpose of this study was to examine the 90-day complications that occurred after intestinal transplantation and to determine whether they effect 5-year patient or graft survivals.

Methods: Retrospective review of intestinal transplant recipients between 11/2003 and 11/2017 at a single-center academic institution. Complications were classified using the Clavien-Dindo classification system. Five-year graft and patient survival were compared between those with varying degrees of complications.

Results: Of the 214 patients who underwent intestinal transplant, 201 (94%) experienced a Grade II or higher complication, 148 (69%) experienced a Grade III or higher complication, 69 (32%) experienced a Grade IV or higher and 13 (6%) patients died (Grade V) within 90 days of transplant. The average number of complications was 2.6. Medical complications occurred in 156 (75%) patients while 132 (64%) patients had a surgical complication of some kind. Medical complications were categorized as infectious (59%), renal (29%), cardiopulmonary (29%), immunologic (26%), gastrointestinal (12%), hematologic (12%) and neurologic (3%). Surgical complications were categorized as enteric (15%), abscess (15%), chylous (14%), bleeding (14%), wound (13%), thrombosis (7%) and biliary (3%). Patients with Clavien-Dindo Grade IV complications had significantly worse five-year graft and overall survival compared to those with less severe complications (57% vs 72%, p= 0.012 and 58% vs 75%, p = 0.007, respectively).

Conclusions: Complications are common after intestinal transplantation and are predominantly infectious. Patients suffering from severe complications (Clavien-Dindo IV) within the first 90 days after transplantation have worse graft and overall survival at 5 years.