P0185 - Recipient Functional Status Impacts on Short and Long-Term Intestinal Transplant Outcomes in US Adults: Evidence from the United Network for Organ Sharing Database 1994-2017

Prince Addo. Ameyaw, MD¹, Sarpong Boateng, MD, MPH², Karthik Mathialagan, MD³, Ruth Zeto, MD, MPH⁴, Yaw A. Adjepong, MD, MPH, PhD^1
1Bridgeport Hospital/Yale New Haven Health, Bridgeport, CT; ²Bridgeport Hospital, Fort Worth, TX; ³Yale New Haven Health/Bridgeport Hospital, Bridgeport, CT; ⁴Harvard T.H. Chan School of Public Health, Boston, MA

Introduction: Recipient functional status prior to transplantation (RFS) has been found to impact post-transplant outcomes in heart, liver and kidney transplants. However, the impact of RFS on short and long-term intestinal transplant (IT) outcomes has not been well-studied. Herein, we investigate the impact of RFS- assessed using the Karnofsky Performance Status (KPS) scale – on short (one-year) and long (ten-year) term intestinal transplant outcomes in United States (US) adults.

Methods: This retrospective cohort study included all 1076 US adults who underwent first-time intestinal transplantation from 1994 to 2017. The primary outcome was mortality. Using the KPS, functional status was categorized as severe functional impairment, moderate functional impairment and normal functional status. Analyses were conducted using Kaplan-Meier curves and multivariable Cox regression. Multivariable models were adjusted for recipient and donor characteristics including (recipient age race, gender, recipient creatinine levels, patient at ICU during transplant, graft total ischemic time, age of donor, and recipient on life support a transplant).

Results: The 1076 recipients ranged in age from 18 to 72 years (Median 43 years). Majority (54.7%) were women. 201 (18.68%) had severe impairment, 298 (27.69%) were moderately impaired and 577 (53.6%) had normal functional status. The median survival time was 1435 days (mean 1902.09 days). The median survival time was 1679 days for recipients with normal KPS, 1462.5 days for those with moderate impairment and 842 days for those with severe impairment. Recipients with severe impairment were 7 times more likely to die at 1 year (HR=7.7; 95%CI= 2.0- 29.3) and 1.2 times at 10 years (HR=2.16; 95%CI= 1.1 - 4.3) compared to patients with no functional impairment.

Discussion: Severe functional limitation at transplant is associated with poorer outcomes in IT recipients. Functional status is an important prognostic indicator for post-transplant outcomes in IT recipients and should be considered in the prognostic counselling and management of patients undergoing intestinal transplant.




Disclosures:


Prince Addo. Ameyaw, MD¹, Sarpong Boateng, MD, MPH², Karthik Mathialagan, MD³, Ruth Zeto, MD, MPH⁴, Yaw A. Adjepong, MD, MPH, PhD¹. P0185 - Recipient Functional Status Impacts on Short and Long-Term Intestinal Transplant Outcomes in US Adults: Evidence from the United Network for Organ Sharing Database 1994-2017, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.