OPTN/SRTR 2024 Annual Data Report: Intestine.

Intestine transplant encompasses multiple surgical procedures for a variety of indications that affect health and quality of life. Intestine transplants are performed with or without liver transplant, sometimes along with concomitant transplant of the stomach, pancreas, and colon in either scenario. In 2024, there were 128 individuals added to the waiting list of candidates who can benefit from an intestine transplant in the United States. Although most candidates had short-gut syndrome, an increasing number of candidates had diagnoses of motility disorders, extensive mesenteric thromboses, or tumors. For the second consecutive year, those awaiting an intestine-without-liver transplant had no reported deaths on the waiting list whereas 11 individuals died awaiting intestine-with-liver transplant. This latter group have a 3-year mortality of nearly 15% once added to the waiting list for intestine-with-liver transplant. In 2024, there were 97 candidates who received an intestine transplant, including 32 recipients in the pediatric age range. Immunosuppression for intestine transplant often includes an induction agent along with prolonged double or triple therapy for maintenance. In recipients of intestine-without-liver transplants in 2017-2019, 1- and 5-year graft survival were 83.2% and 54.5% in adults and 77.1% and 54.3% in pediatric recipients, respectively. For recipients of intestine-with-liver transplants, 1- and 5-year graft survival were 51.9% and 41.6% in adults and 82.7% and 60.5% in pediatric recipients, respectively. Nearly half (44%) of the most recent intestine transplant cohort had acute rejection within the first year after transplant. As intestine transplant is used for a wider range of indications, the shifting diagnoses and demographics of those receiving intestine transplants will be a key feature of future reports.