TY - JOUR
T1 - Developing trends in the intestinal transplant waitlist
AU - Khan, K. M.
AU - Desai, C. S.
AU - Mete, M.
AU - Desale, S.
AU - Girlanda, R.
AU - Hawksworth, J.
AU - Matsumoto, C.
AU - Kaufman, S.
AU - Fishbein, T.
N1 - Publisher Copyright:
Copyright © 2014 The American Society of Transplantation and the American Society of Transplant Surgeons.
PY - 2014/12/1
Y1 - 2014/12/1
N2 - The United Network for Organ Sharing database was examined for trends in the intestinal transplant (ITx) waitlist from 1993 to 2012, dividing into listings for isolated ITx versus liver-intestine transplant (L-ITx). Registrants added to the waitlist increased from 59/year in 1993 to 317/year in 2006, then declined to 124/year in 2012; Spline modeling showed a significant change in the trend in 2006, p-<-0.001. The largest group of registrants, <1-year of age, determined the trend for the entire population; other pediatric age groups remained stable, adult registrants increased until 2012. The largest proportion of new registrants were for L-ITx, compared to isolated ITx; the change in the trend in 2006 for L-ITx was highly significant, p-<-0.001, but not isolated ITx, p-=-0.270. New registrants for L-ITx, <1-year of age, had the greatest increase and decrease. New registrants for isolated ITx remained constant in all pediatric age groups. Waitlist mortality increased to a peak around 2002, highest for L-ITx, in patients <1-year of age and adults. Deaths among all pediatric age groups awaiting L-ITx have decreased; adult L-ITx deaths have dropped less dramatically. Improved care of infants with intestinal failure has led to reduced referrals for L-ITx. Data from the United Network of Organ Sharing indicate that the number of infants, historically the largest group on the waitlist for liver-intestine transplantation, has reduced dramatically since 2006 while other pediatric groups have remained the same and adults have increased.
AB - The United Network for Organ Sharing database was examined for trends in the intestinal transplant (ITx) waitlist from 1993 to 2012, dividing into listings for isolated ITx versus liver-intestine transplant (L-ITx). Registrants added to the waitlist increased from 59/year in 1993 to 317/year in 2006, then declined to 124/year in 2012; Spline modeling showed a significant change in the trend in 2006, p-<-0.001. The largest group of registrants, <1-year of age, determined the trend for the entire population; other pediatric age groups remained stable, adult registrants increased until 2012. The largest proportion of new registrants were for L-ITx, compared to isolated ITx; the change in the trend in 2006 for L-ITx was highly significant, p-<-0.001, but not isolated ITx, p-=-0.270. New registrants for L-ITx, <1-year of age, had the greatest increase and decrease. New registrants for isolated ITx remained constant in all pediatric age groups. Waitlist mortality increased to a peak around 2002, highest for L-ITx, in patients <1-year of age and adults. Deaths among all pediatric age groups awaiting L-ITx have decreased; adult L-ITx deaths have dropped less dramatically. Improved care of infants with intestinal failure has led to reduced referrals for L-ITx. Data from the United Network of Organ Sharing indicate that the number of infants, historically the largest group on the waitlist for liver-intestine transplantation, has reduced dramatically since 2006 while other pediatric groups have remained the same and adults have increased.
KW - Clinical research/practice
KW - Organ Procurement and Transplantation Network (OPTN)
KW - intestine/multivisceral transplantation
KW - waitlist management
UR - http://www.scopus.com/inward/record.url?scp=84910638100&partnerID=8YFLogxK
U2 - 10.1111/ajt.12919
DO - 10.1111/ajt.12919
M3 - Article
C2 - 25395218
AN - SCOPUS:84910638100
SN - 1600-6135
VL - 14
SP - 2830
EP - 2837
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 12
ER -