History of intestinal transplantation in Australia

TL;DR

Australia started intestinal transplants in 2010, centralizing care in Melbourne to achieve good patient outcomes despite challenges.

Contribution

The paper documents the successful establishment of a centralized intestinal transplant service in Australia.

Findings

Centralization led to 5-year graft and patient survival rates comparable to international centers.

Challenges included staff training, protocol development, and donor organ allocation across a large geography.

National deficiencies in intestinal failure management remain a barrier to timely access.

Abstract

Intestinal transplantation was introduced into Australia in 2010 to meet the need of a small number of patients with irreversible intestinal failure who would otherwise need to travel abroad to access this life-saving therapy. Due to small case numbers, a single center based in Melbourne, Victoria, services all of Australia and New Zealand. Centralization of clinical activity has resulted in excellent patient outcomes, with 5-year graft and patient survival matching that of the more experienced international centers. However, on the path to establishing a successful service, multiple significant challenges were encountered, including training of staff, surgical and immunosuppression protocol development, and donor organ acceptance and recipient allocation based on the vast geography of Australia. Deficiencies in intestinal failure management on a national level have posed some further concerns regarding timely access to and referral for transplantation. Herein we discuss the establishment of an intestinal transplant service in Australia, how challenges were overcome and what barriers remain.

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