Outcomes Following Graft Enterectomy After Intestinal and Multivisceral Transplantation: A Multicenter Analysis

Background: Graft enterectomy following intestinal (IT) or multivisceral transplantation (MVT) significantly impacts patient morbidity and survival.However, data on IT failure requiring enterectomy and post-enterectomy outcomes remain limited.This study aims to describe clinical outcomes for patients who underwent enterectomy.Methods: A retrospective analysis from four transplant centers who underwent graft enterectomy after IT or MVT was conducted (2012-2024).The primary outcome was patient survival, with secondary outcomes including transplantation and infection within 3 months.Results: Among the 20 patients (10 men, 10 women), 55% received transplants before age 18.The average age at enterectomy was 21 years (median 7 years), with pediatric patients averaging 4 years and adults 45 years.IT alone accounted for 75% of transplants, and 25% were MVT.Rejection was the primary reason for enterectomy in all cases.MVT recipients had significantly higher re-transplantation rates and showed a trend toward improved survival (p=0.40).At 6 months and 1 year post-enterectomy, survival rates were 73% and 67% for IT recipients, and 80% at both time points for MVT recipients.Pediatric recipients had higher survival than adults (p<0.01).There was no significant difference in post-enterectomy infection or PTLD development between IT and MVT recipients.Conclusions: Graft enterectomy is a major event following IT and MVT, with rejection as the primary cause.MVT recipients had higher survival rates and re-transplantation rates, while pediatric patients fared better than adults.Improved immunosuppressive protocols and monitoring are needed to reduce graft failure risks.Further research is essential for long-term survival and quality of life improvements.