Background: Isolated intestinal transplant (ITx) is indicated for patients with irreversible intestinal failure requiring parenteral nutrition with complications. Multivisceral transplant (MVTx) is reserved for patients with irreversible failure of multiple organs including small bowel. Aim: We describe outcomes of ITx and MVTx in a transplant center working with an underserved urban adult patient population. Method: Between August 2010 and December 2012, seven patients completed isolated intestine (57%) or multivisceral transplantation. Median age was 50 (range 22-53). 29% were African American and 43% female. Indications for ITx were short bowel syndrome due to Crohn’s disease (1), mesenteric ischemia (1), Volvulus (1) and gunshot wound (1). Indications for MVTx were metastatic neuroendocrine cancer (2) and Crohn’s disease (1). Immunosuppression included induction with rituximab and thymoglobulin and maintenance using tacrolimus, methylprednisolone and monthly basiliximab. Cytomegalovirus (CMV) prophylaxis was given to patients at increased risk with CMV immune globulin and maintenance on valgancyclovir for one year. Graft surveillance was performed by monthly endoscopy for six months post transplant. Results: One year patient survival was 100%. One year graft survival was 86%. Median length of stay after transplantation was 24 days. One MVTx patient (14%) had mild acute cellular rejection at 2 months after transplant which resolved with uptitration of tacrolimus and methylprednisolone. One ITx patient had severe acute cellular rejection within one day of transplant requiring urgent removal of the implant. One patient had acute renal failure managed with addition of everolimus. One patient developed mild graft versus host disease with skin rash resolved with basiliximab. One patient had metastatic carcinoid unexpectedly involving the pancreas on explant. This was addressed through addition of everolimus and cessation of tacrolimus, with no recurrence of cancer at one year post transplant. There was no CMV infection in any patients. In comparing ITx patients with MVTx patients, there is no statistical difference in graft survival, patient survival, rejection rate or length of stay (p>0.05). Conclusion: We demonstrate successful patient outcomes of isolated intestine and multivisceral transplantation in a transplant center working with an underserved urban adult population.

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