On behalf of the UK national intestinal transplant programmes

Introduction: Intestinal transplantation in the UK has been centrally commissioned at four centres since 2008; two paediatric centres (Birmingham Children’s Hospital and King’s College Hospital) and two adult centres (Cambridge Addenbrooke’s Hospital and Oxford Churchill Hospital). The programme has evolved; this study describes the trends over the last 10 years. Mandatory data are collected centrally by National Health Service Blood and Transplant (NHSBT).

Methods: All patients were included who were registered for or received an intestinal transplant. These were classified as: bowel only (small bowel +/- colon/abdominal wall/kidney, BO), multi-visceral (liver, small bowel, pancreas +/- stomach/kidney/colon, MV), or modified multi-visceral (small bowel, pancreas +/- stomach/kidney/colon/abdominal wall, MMV)) between 1 April 2008 and 31 March 2018 were extracted from the UK Transplant Registry held by NHSBT. Trends in age, diagnosis, transplant type and survival post-transplant were analysed.

Results: During the decade, 196 intestinal transplants were performed nationally with an annual increase from 16 in 2008/09 to 26 in 2017/18. Since 2011/12 more transplants have been performed in adults than children, with 65% in adults during the latest year compared with 38% during 2008/09. BO transplants represented 72% of all transplants performed in 2010/11 compared with 27% in the latest year, due to increases in both MV and MMV transplants.

There were 251 registrations onto the transplant list, of which 45% were for short-bowel syndrome, 15% motility disorders, 9% tumour, 9% re-grafts, 6% mesenteric thrombosis, 5% intestinal failure associated liver disease, 4% primary mucosal disorders and 5% other identified causes. Short-bowel syndrome has been reported less in recent years.

Of patients placed on the waiting list, 78% were transplanted. One year post-transplant patient survival rates are 78% (69%-85%) and 85% (73%-92%) for adults and children respectively.

Conclusion: The UK programme transplants 14-26 patients per year, with a trend over time towards adult patients, multi-visceral transplants and away from short-bowel syndrome.