Adult Only Intestinal Retransplant Is Associated With Higher Rates of Graft Failure, Acute Rejection, and Mortality: A United Network for Organ Sharing Database Analysis

Objectives: Adult intestinal retransplant has increased substantially during the past decade, outpacing the rate of primary transplants to become the fourth most common reason for intestinal transplant. Although intestinal retransplant is a viable option for patients with failed transplants, long-term survival is often lower. We compared intestinal retransplant to primary intestinal transplant for rates of graft failure, acute rejection, and mortality. Materials and Methods: We collected data from the United Network for Organ Sharing database for intestinal retransplant and first-time intestinal transplant for the period from 2010 to 2024. We compared recipient and deceased donor characteristics of primary intestinal transplant alone and intestinal retransplant via Pearson chi-square tests. We contrasted graft failure, mortality, and acute rejection by using log-rank tests, multivariate Cox analysis, and logistic regression analysis. Results: We selected 741 patients; 60 (8.1%) were intestinal retransplant recipients. On log-rank tests, intestinal retransplant showed 20% higher rate of graft failure and mortality after 5 years (P < .001). Regression analysis showed that retransplant was associated with 61% higher rate of graft failure (hazard ratio = 1.615, P = .002), 107% higher rate of acute rejection (odds ratio = 2.072, P = .049), and an 82% increase in mortality (hazard ratio = 1.823, P < .001). No associations between sex, race and ethnicity, or induction or maintenance regimens and graft failure or mortality for intestinal retransplant were shown. Conclusions: Adult intestinal retransplant was associated with higher rates of graft failure related to rejection and infection, and retransplant status was associated with higher rates of graft failure and mortality. No associations between different regimens of induction or maintenance and graft failure or mortality were shown. Race/ethnicity and sex did not affect graft failure or mortality. Further research of intestinal retransplant will improve knowledge of risk factors associated with negative outcomes.