Introduction: The establishment of our multidisciplinary Intestinal Failure (IF), Rehabilitation and Intestinal Transplant (ITx) Program in Argentina in 2006 opened the possibility to IF patients (Pts) to receive a comprehensive approach. This field is in continuous evolution worldwide, requiring frequent updates and adjustments.  We aim to report the evolution of the program, the impact on the ITx area, and the challenges to overcome. 

Methods: retrospective analysis of a prospectively filled database of IF Pts from 03-2006 to 02-2017. Number of Pts evaluated, Pts listed for ITx, indication for ITx, time on the waiting list (WL), type of ITx, mean total ischemia time (TIT),  mean warm ischemia time (WIT), 1, 3 and 5-year actuarial Pt survival, cause of death and graft loss are reported overall, and also divided in 3 periods: 2006-2009 (P1); 2010-2013 (P2) and 2014-2017 (P3).

Results: 310 Pts with IF were referred, 83 were considered for autologous gastrointestinal reconstruction surgery with increasing applicability over the studied period; 91 Pts were evaluated for ITx; main indications for ITx were lack of central venous accesses followed by parenteral nutrition associated liver disease, and catheter related infectious complications (table 1). The number of pre-Tx evaluations did decrease overtime, as well as the need for liver containing Tx. The mean time on the WL increased significantly (p=0.006; table 1); 8 Pts are currently awaiting ITx (4 highly sensitized, 2 of them awaiting re-Tx). At a mean follow-up time of 53±49 months, and in concordance with the reduction of the number of pre-Tx evaluations, the number of ITx performed by period has decreased. Sepsis has remained the main cause of early death, while severe exfoliative rejection and chronic rejection continue to be the leading causes of graft loss (table 1). 

Conclusions: Over the first 11 years of the program, there has been a sustained increase in the total number of referrals, with a steady reduction in the number of pre-Tx evaluations and ITx performed, favouring surgical rehabilitation. The overall long-term post ITx survival has remained comparable to larger centers, but late graft loss has progressively increased, rising with the proportion of highly sensitized patients on the WL. The establishment of a closer immunological follow up, the creation of strategies to avoid non compliance, the application of effective desensitizing protocols and new immunosuppressive strategies are some of the challenges to be faced to improve long term results.