149: Intestinal transplantation for intestinal motility disorders

Introduction: Intestinal mobility disorder (MD) is a major cause of severe intestinal failure requiring intestinal transplantation (ITx), especially in Asian countries. This study aimed to assess the outcome of ITx for patients with MD. Methods: Between 2003 and 2022, 11 patients underwent ITx at our institution. Underlying MD was identified in eight patients, and short gut syndrome in the remaining three. Patients with MD were divided into two groups according to Era: Era I (2003-2010, n=4) and Era II (2011-2022, n=4). A retrospective review was performed to evaluate the patient characteristics, operative data, patient and graft-survival rates, and incidence of complications, including acute rejection (AR). Results: Patient’s age at the time of primary ITx in Era I was higher than in Era II (median, 20 years vs. 15 years). In Era I, hypoganglionosis (n=2) and chronic idiopathic intestinal pseudo-obstruction (CIIPS) (n=2) were diagnosed, while in Era II, hypoganglionosis (n=1), CIIPS (n=1), megacystis microcolon intestinal hypoperistalsis syndrome (n=1), and extensive aganglionosis (n=1). An induction immunosuppressive treatment included an interleukin-2 receptor antagonist in Era I and rabbit antithymocyte globulin in Era II. Furthermore, the donor type was living (n=2) and cadaveric (n=2) in Era I and all cadaveric (n=4) in Era II. Median durations of follow-up after ITx were 102 and 81 months in Era I and II, respectively. One-, 5-, and 10-year patient survival rates were 100%, 75%, and 44.4% in Era I and 100%, 100%, and 100% in Era II, respectively (p=0.1). Three patients in Era I died: one due to sepsis, another due to abdominal bleeding, and the other due to acute pancreatitis. In comparison, 1-, 5-, and 10-year graft survival rates were 75%, 50%, and 25% in Era I and 100%, 100%, and 100% in Era II, respectively (p=0.07). The incidences of moderate or severe AR and medical complication including renal deficiency and diabetes mellitus, were 100% and 50%, respectively, in Era I and 50% and 75%, respectively, in Era II. Three patients (one in Era I; two in Era II) were completely weaned from parenteral nutrition. Conclusions: The ages and underlying disease of patients had enlarged by Era. Although patient- and graft-survival rates in Era II were superior to those in Era I, the incidence of AR and medical complications were similar between Era.