BTS 2012 Report – Intestinal transplant activity and outcome

by Maria Dalby reporting on the presentation by Kerri Barber, Bowel Advisory Group, NHS Blood and Transplant.  Intestinal transplantation activity is low compared with other solid organ transplantation within the NHS – in recent years, only around 20 intestinal transplantations have been carried out annually. Kerri Barber, statistician at NHS Blood and Transplant (NHSBT) presented data from the UK Transplant Registry (UKTR) showing that 1-year survival rates following intestinal transplantation has improved in recent years for both adult and paediatric patients.

Four centres in the UK are commissioned to carry out intestinal transplantations: paediatric patients are referred to the Birmingham Children’s Hospital or King’s College Hospital in London, and adult patients go to either Addenbrooke’s in Cambridge or the Oxford Radcliffe Hospitals NHS Trust. In addition, St James’ University Hospital in Leeds was commissioned between 1994 and 2008. Ms Barber and colleagues collected transplant data on patient survival over a 20-year period (from 1 July 1991 to 31 December 2011); a total of 49 adults and 109 children underwent transplantation in this period. The majority of the children underwent bowel-only or liver, bowel and pancreas transplantations, with a marked increase in the proportion of bowel-only transplantations seen from April 2008 onwards. In adults, around one third of patients underwent bowel-only transplantations; the proportion of multi-visceral transplantations without the liver increased from April 2008 onwards, and in the same period the proportion of liver-only transplantations decreased dramatically from 29% to only 3%.

No significant difference in patient survival was seen between adults and paediatric patients, neither in the short (90 days and 1 year) nor long (5 years’) term. Whilst the long-term data in the adult population should be interpreted with caution due to the limited patient numbers and long observation period, 5-year survival in children was estimated at 57% for the entire cohort. Survival rates were similar in the adult and paediatric cohort and in the short and long term, independently of at what point in time during the data collection period the transplantation had been carried out and what type of transplantation had been performed. In the period between April 2008 and December 2011, 70% of both children and adults on the waiting list underwent intestinal transplantation; around 10-12% remain on the waiting list as of February 2012 (equivalent to around 15-20 patients at any one time – at the time of the presentation, 11 adults and 6 children in the UK await intestinal transplantation). Ms Barber and colleagues will continue this project by integrating the process of registration and organ allocation for intestinal transplantation with the appropriate processes with the UKTR, to bring them into line with those for other organ groups and to develop a robust organ allocation procedure for bowels in the UK.