Graft-versus-host Disease Post Visceral Transplantation – A Swedish Single Center Experience

Background: Paediatric patients awaiting combined liver and intestinal transplant (LITx) face a high risk of deterioration.We aimed to evaluate whether perceived long wait times for these patients would increase waitlist mortality or necessitate life-saving isolated liver transplantation.Methods: A retrospective case review of LITx candidates (n=50), evaluated waitlist mortality as the primary outcome.Subgroup analyses compared patients requiring urgent isolated liver transplantation due to deterioration with those receiving other grafts.Statistical analyses included survival analysis, correlation between wait times and mortality, and multivariate regression to identify predictors of waitlist death.Results: Median transplant wait-time was 209 days (20-1248), longer than recent UK adult registry data of median 54 days.Waitlist mortality was 20%.Intestinal Failure Associated Liver Disease (IFALD) was the key risk-factor, with 27.6% mortality among IFALD patients compared to 0% in non-IFALD (p=0.035).In IFALD, extended wait-time (r=0.663,p<0.001) and higher referral bilirubin levels (r=-0.424,p=0.024) predicted poorer outcomes.Eight patients (16%) underwent isolated liver transplantation due to clinical deterioration.These patients had shorter median wait-times (379.5 vs 411.7 days) and higher serum bilirubin levels(179.3 vs 116.9mol/L) than those receiving other transplants.Conclusions: These findings highlight the need for timely transplantation, particularly for IFALD.Early consideration of isolated liver transplantation as a life-saving bridge for rapidly deteriorating patients is required.Further measures, such as increased use of living-related liver bowel transplant and machine perfusion, may be needed to reduce long wait times.