UK Intestinal transplant program

Background: Since 1/2013, we performed 175 primary ITx under new immunosuppressive, medical, and surgical strategies.From 3/2013-3/2015, of 34 ITx, 11% developed GVHD with 100% mortality in confirmed cases.Peripheral blood chimerisms were obtained with clinical suspicion only.When then began tracking serially, specifically T cell %, to define natural history during early post-operative period in those that do and do not develop GVHD.Methods: From 3/2015-4/2023, 116 ITx were done.Tchim % collected weekly for 14 wks post-transplant.The frequency then decreased through 1 yr.13 patients had graft loss 1 st 2 wks and excluded.Of remaining 103, 33 Isolated ITx (IITx), 10 Modified Multivisceral (MMVT) and 60 MVT were analyzed.Results: No IITx developed GHVD.Tchim% remained <10% in all patients during the 1st 14 wks except in 4(12%); 3 had a single value >10% and 1 >20%.15(15%) of 103 patients had clinically suspected or confirmed GVHD; 3 MMVT and 12 MVT.13 had (3) consecutive Tchim% >25% within 1st 14 wks preceding symptoms.2 had very high Tchim% >60% x 2 in 1 st month with +skin biopsy and treated early.All patients suspected of or confirmed GVHD had at least (1) level >25% within the 1 st 6 wks.Conclusions: Persistent Tchim >25% should herald careful screening for GVHD symptoms.If elevation persists for 3 wks it is nearly diagnostic of future GVHD.Earlier diagnosis of GHVD may improve long-term survival of this dire complications.