Impact of Sarcopenia on Survival and Longitudinal Body Composition Changes in Visceral Transplant Recipients

Background: Access to intestinal rehabilitation and transplantation units (IRTUs) is still limited worldwide, leading to disparities in care.Long-term outcome analysis from established centers is essential to define best practices and develop standardized benchmarking strategies.This study aims to assess the evolution of key performance indicators in a pediatric IRTU over two distinct periods (Era 1: 1996(Era 1: -2010;; Era 2: 2011 Era 2: -2024) ) Methods: A retrospective cohort study was conducted on all pediatric IF patients treated at a national referral IRTU between 1996 and 2024.Patients were categorized into diagnostic groups: short bowel syndrome (SBS), motility disorders, mucosal disorders, tumors, and "other".Outcome measures included referral trends, survival, enteral autonomy, and transplantation.Results: Over 28 years, 405 patients were managed at the IRTU.Annual referrals increased from 1 to 21 patients/year.The diagnostic distribution remained stable across eras: SBS (72% vs. 67%), motility disorders (15% vs. 16%), and mucosal defects (9% vs. 9%).Significant improvements in survival were observed from Era 1 to Era 2 (five-year overall survival 60% vs. 85%, p<0,05).The need for intestinal transplantation (42% vs. 16%) and mortality on the transplant waiting list significantly decreased (12% vs. 3%), while the proportion of patients achieving enteral autonomy without transplantation increased (36% vs. 49%).Conclusions: The increasing number of referrals, improved survival rates, a reduced need for transplantation, and lower waiting-list mortality underscore significant advances in intestinal rehabilitation.Standardized outcome reporting is crucial for international benchmarking, fostering the knowledge exchange required for new IRTUs worldwide.