S3060 Trends and Indications for Intestinal (Small Bowel) Transplantation in the United States: A 12-Year Analysis (2012–2023) Using UNOS Data

Introduction: Intestinal (Small Bowel) transplantation remains a rare but life-saving intervention for patients with irreversible intestinal failure, often accompanied by liver dysfunction. Understanding evolving indications and procedural trends is essential for improving outcomes and guiding healthcare policy. Methods: We conducted a retrospective analysis of intestinal transplant data from the United Network for Organ Sharing (UNOS) database between 2012 and 2023. Transplant volumes were stratified by indication, type (intestine-only vs combined liver-intestine), and year. Primary etiologies included congenital short gut syndrome (SGS), enteropathies, necrotizing enterocolitis (NEC), non-congenital SGS, pseudo-obstruction, and other/unknown causes. Results: There was a marked decline in total intestinal transplant volume over the 12-year period, decreasing from a peak of 147 transplants in 2016 to 95 in 2023, representing a 35% overall reduction. Non-congenital short gut syndrome (SGS) was the most common indication throughout all years. In contrast, congenital SGS showed a steep decline, falling from 28 cases in 2014 to just 7 in 2023. Other etiologies, such as necrotizing enterocolitis (NEC), pseudo-obstruction, and enteropathies remained relatively stable, contributing a smaller portion of cases. The “Other/unknown” category showed notable variability, with a peak of 39 cases observed in 2015. Intestine-only transplants consistently outnumbered combined liver-intestine procedures. While intestine-liver transplants peaked in 2014 and 2016 with 35 and 32 cases respectively, the number declined to 16 by 2023. Conclusion: UNOS data from 2012–2023 reveal a steady decline in intestinal transplant volume, despite stable indications. The reduction may reflect advances in intestinal failure management, including parenteral nutrition and surgical approaches. Continued surveillance of transplant trends and outcomes is warranted to inform clinical and policy decisions.