Does Venous Drainage Route Matter? Portal Versus Systemic Drainage in Isolated Intestinal Transplantation: An Analysis of the National UNOS Database.

BACKGROUND

Type of venous drainage in isolated intestinal transplantation (ITx) may influence immune responses through hepatic filtration of gut-derived antigens and affect outcomes.

METHODS

We analyzed United Network for Organ Sharing data from 2013-2023 to compare portal versus systemic drainage in pediatric and adult ITx recipients. Graft and patient survival were assessed using Kaplan-Meier and Cox proportional hazards models, and acute rejection during the index admission was evaluated with multivariable logistic regression.

RESULTS

Among 480 recipients (137 pediatric, 343 adult), systemic drainage in pediatric patients was associated with higher acute rejection rates (50.7% vs. 32.4%, p = 0.029), and adjusted analysis confirmed systemic drainage as an independent risk factor (OR 2.32, 95% CI 1.00-5.37, p = 0.049). No survival differences were observed between drainage types in either age group.

CONCLUSION

While venous drainage type did not affect long-term graft or patient survival, portal drainage in pediatric ITx was associated with lower odds of early acute rejection, suggesting a potential immunologic benefit that warrants prospective validation.