DOP127Crohn’s disease and intestinal/multivisceral transplant: Who needs it and what are the outcomes? Experience from a High-Volume Centre

Background Intestinal/multivisceral transplant (IT/MVT) remains the least frequent solid organ transplant, generally indicated in patients with severe complications of intestinal failure (IF) (1). Crohn’s disease (CD) may lead to IF through multiple mechanisms (2) yet published evidence on transplant outcomes in this setting is scarce. The primary aim of this study was to describe the outcomes of CD patients who underwent IT/MVT in our centre. Methods We retrospectively reviewed CD patients undergoing IT/MVT between 2008 and 2024 at Cambridge. Baseline CD characteristics, surgical history, indication for transplant (Table 1), and transplant characteristics and outcomes (Table 2) were collected. Survival was analysed using Kaplan–Meier and stratified by grafts including or not including liver (Figure 1). Results A total of 24 patients receiving 25 transplants (including 1 retransplant) were included. Fifty-four percent were male, most diagnosed at A2 age (58%), with ileocolonic disease (92%) and proximal involvement in 54%. 83% had stricturing or penetrating behaviour, with a median CD duration of 28.5 years. Prior therapy included immunomodulators (75%) and biologics (71%). Patients had a median of 5 previous surgeries and residual small bowel length of 70 cm; despite this, 58% had active CD at the time of transplant. Short bowel syndrome was the leading cause of IF (83%), and the main indication for transplant was IF-associated liver disease (48%). Median age at transplant was 50 years, with a median follow-up of 35 months; 56% received grafts excluding liver. Although 40% experienced rejection episodes, at last follow-up 88% had complete intestinal function without artificial nutritional support. Three patients developed CD recurrence, which did not result in graft loss. Overall survival is shown in Table 2; in patients with grafts excluding liver, survival was 100%, 90.9% and 90.9% at 1, 3 and 5 years, respectively. Conclusion Our experience shows that in patients with severe, long-standing CD leading to IF and life-threatening complications, IT/MVT is a valuable therapeutic option with excellent outcomes. We recommend early referral of similar cases to specialised centres with expertise in IF and IT/MVT. References: 1. Pironi L, Arends J, Bozzetti F, et al. ESPEN guideline on chronic intestinal failure in adults. Clin Nutr. 2021;40(9):5196-5220. 2. Limketkai BN, Parian AM, Shah ND, Colombel JF. Short Bowel Syndrome and Intestinal Failure in Crohn’s Disease. Inflamm Bowel Dis. 2016;22(5):1209-18. Conflict of interest: López Romero-Salazar, Francisco: Author reports educational/travel grants and/or speaker fees from AbbVie, Dr Falk, J&J, Lilly, Pfizer and Takeda. Butler, Andrew: No conflict of interest Amin, Irum: No conflict of interest Massey, Dunecan: No conflict of interest Neil, Russell: No conflict of interest Woodward, Jeremy: No conflict of interest Rutter, Charlotte: No conflict of interest