141: Long term outcomes after intestinal transplantation at a single center in Argentina.

Introduction: The establishment of the first multidisciplinary comprehensive intestinal failure (IF) program in Argentina opened the possibility to patients (Pts) with IF to receive Intestinal transplant (ITx) when indicated. The field has evolved favouring intestinal rehabilitation over ITx worldwide, impacting on the ITx activity. We aim to report the long term ITx applicability and outcomes at a single center. Methods: Retrospective analysis of a prospectively filled database of ITx Pts from 03-2006 to 01-2023. Number of ITx performed, indications for ITx, time on the waiting list (WL), type of ITx, mean total ischemia time (TIT), mean warm ischemia time (WIT), 1, 3, 5 and 10 year actuarial Pts and graft survival, cause of death and graft loss are reported overall, and divided by periods: 2006-2013 (P1) and 2014-2023 (P2), and according to age group: Children (C) and Adults (A). Results: 53 ITx were performed in 48 pts (20 ITx/19 A, 33 ITx/29 C), 36 Male (68%); 40 ITx were done in P1 and 13 in P2 (p=0.04). Short gut syndrome was present in 79%, the main indications for ITx were: lack of central venous access (47%) followed by PNIFLD (23%), and catheter related sepsis (8%). Mean time on PN before ITx was1732± 2049 days. The overall mean time on the WL was 240±258 days (P1:186±187 days and P2:405±369 days [p=0.007]). Thirty nine ITx were isolated (74%, 27 C and 12 A; 3 re-Tx, 31 in P1), 8 multivisceral transplants (MTV) (15%; 3 C and 5 A; 1 Re-Tx, 1 mMTV, 2 with kidney (KD), 6 in P1), and 6 combined liver-Itx (11%, 3 C and 3 A; 1 Re-Tx, 2 with KD, 3 in P1). Mean TIT was 399±126 min, TIT in P1 was 420±128 min., while in P2 was 332±96 min (p=0.02). Mean WIT was 39±11min, 40±10min in P1,and 38±14 min in P2 (p=ns). Overall pts and graft survival at 1, 3, 5 and 10 years were: 70%, 64%, 55% and 40% and 69%, 61%, 50%, 29% respectively. No statistical differences were observed when periods, recipient age and type of Tx were compared. Sepsis remains the main cause of early death, while severe exfoliative rejection and chronic rejection continue to be the leading causes of graft loss. Conclusions: Over the first 17 years, our program was able to sustain ITx activity despite a significant reduction in the number of cases, and longer time on de WL. TIT was improved, type of Tx proportions remain unchanged. Late graft loss has progressively increased, mainly as consequence of late acute or chronic rejection. The overall long-term survival remains comparable to larger programs. This activity has positioned our center among the 20 most active programs worldwide, and the most active in the region.