Aim. Intestinal transplant (ITx) recipients frequently require repeat hospital admissions after successful transplant, increasing costs and causing significant burden on families. The causes of hospital re-admission after ITx have not yet been characterized. As a preliminary step of a strategy to reduce preventable re-admissions, we reviewed our single center experience over a decade to determine patterns and causes of hospital re-admission after ITx.

Patients and Methods. 87 adults received an intestine-containing graft (isolated intestine n=66, liver-intestine n=1, multi-visceral or modified multi-visceral graft n=20) at our center since 2004. Re-transplants (n= 7) and recipients who died or lost the graft ≤1 year since transplant (n=15) were excluded. A total of 65 patients (35 M, 30 F, median age 42 y [range 19-66]) were included. Re-admission was defined as any post-ITx inpatient hospital stay ≥24 hours, excluding planned re-admission for ostomy closure. We analyzed incidence, cause, timing and duration of early (≤30 days) and late (month 2-12) re-admission after ITx.

Results. The median initial transplant hospital stay was 27 days (11-129). After discharge, 44/65 patients (68%) required early and 59/65 patients (91%) required late re-admission at least once post-ITx. The three most common causes of re-admission were dehydration, infection and surgical complications both early (29%, 22%, 9 %) and late (29%, 19%, 9.5%). Acute cellular rejection was the 4^th most common cause (7.6%) of late readmission. In total, 333 re-admissions occurred ≤1 year of initial discharge (early n=69, 21%, late n=264, 79%) with a median of 4 re-admissions/patient (0-22) and a combined total duration of 4089 hospital days (median 7 days/re-admission, [2-136]).

Conclusion. In our series ITx recipients required a median of 4 re-admissions/patient within the first year post-transplant, less than twice the literature-reported rate for liver transplant recipients. Unlike other transplants where the most common re-admission cause is infectious complications, the most common cause for re-admission for ITx was dehydration/AKI, likely related to the temporary ileostomy. Future studies on pre-discharge education and post-discharge follow-up on hydration status are needed to implement prevention strategies and reduce readmission rates.

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