UPMC Children’s Hospital of Pittsburgh at CIIRTA 2025: Advancing Intestinal Failure Rehabilitation and Transplant Care

UPMC Children’s Hospital of Pittsburgh physicians and researchers, in collaboration with national and international colleagues, participated in the 19^th Congress of International Intestinal Rehabilitation and Transplantation Association (CIIRTA) in Gothenburg, Sweden. The biennial meeting brings together international experts in the field of intestinal failure, rehabilitation, and transplantation, to share research, knowledge, and new advancements in intestinal health related care.

George Mazariegos, MD, chief, pediatric transplantation, delivered the keynote address, and Simon Horslen, MD, director, pediatric hepatology, presented on long term management of intestinal failure. UPMC experts also collaborated on three multicenter studies examining graft salvage, epidemiologic tracking, and posttransplant rehabilitation.

Presented Abstracts Summary

Outcomes Following Graft Enterectomy After Intestinal and Multivisceral Transplantation

Graft enterectomy performed post intestinal or multivisceral transplant has been shown to impact patient morbidity and survival. This study evaluated survival and re-transplantation patterns in recipients undergoing enterectomy after intestinal or multivisceral transplantation.

The retrospective multicenter analysis was performed across four transplant centers and examined 20 patients who underwent graft enterectomy after intestinal or multivisceral transplant between 2012-2024. 55% were transplanted before age 18, and the average age at the time of enterectomy was 21 years old. 75% underwent intestinal transplant and 25% underwent multivisceral transplant. Rejection was the primary cause of enterectomy in all cases.

Results:

• Six-month survival post-enterectomy: 73% (intestinal) and 80% (multivisceral)
• One-year survival post-enterectomy: 67% (intestinal) and 80% (multivisceral)
• Pediatric patients had significantly higher survival than adults (p < 0.01).
• Multivisceral recipients showed higher re-transplantation rates and a trend toward improved survival compared with intestinal transplant recipients.
• No significant differences were observed in infectious complications or posttransplant lymphoproliferative disease between intestinal vs. multivisceral transplant.

Implications

Rejection being the cause of enterectomy in all cases emphasizes the challenge of immune-mediated graft loss. This study demonstrates the need for enhanced immunosuppressive strategies to reduce the incidence of graft failure leading to enterectomy. The data suggests that centers should plan for the possibility of enterectomy and re-transplantation, particularly in younger patients.

For transplant centers with intestinal and multivisceral programs, these findings suggest that proactive strategies, such as early identification of rejection, robust monitoring, and consideration of pre-emptive therapies, may improve long-term outcomes.

Read the full abstract.

Adoption and Utilization Trends of a New Diagnosis Code for Pediatric Intestinal Failure

Prior to 2023, pediatric intestinal failure did not have a dedicated ICD-10 diagnosis code. As a result, its epidemiology has remained underreported in administrative datasets. Researchers analyzed Pediatric Health Information Systems data to evaluate how hospitals are adopting the new ICD-10 code for pediatric intestinal failure, K90.83.

The study’s cohort included 1,549 inpatient encounters from 956 unique patients across 45 hospitals. Median patient age was 4.6 years old (IQR 1.4-10.9) and 43% were female. Short bowel syndrome (SBS) was coded in 796 encounters as was parenteral nutrition (PN) use in 1,335 encounters.

Patients without a PN code had shorter median length of stay (five days) compared to those with PN (10 days), p < 0.001. There was no association between use of the PN code and the SBS code. Usage of the new intestinal failure code did not initially increase, but after a lag period of 8 months, code usage began to increase at 1.3% per month. No associations were observed between code usage and race, gender, payor, or concurrent code usage.

Implications

Introduction of ICD-10-CM code K90.83 provides the first formal mechanism for capturing pediatric intestinal failure across institutions.

The 8-month delay in uptake suggests that coding adoption is not instantaneous, potentially limiting early analyses of trends or comparisons across centers. With consistent use, the code will enable more accurate tracking of outcomes, resource utilization, and multicenter quality efforts.

Read the full abstract.

Glucagon-Like Peptide-2 Therapy Outcomes Following Intestinal and Multivisceral Transplantation

Intestinal transplant patients often struggle with chronic malabsorption and prolonged total parenteral nutrition (TPN). While Glucagon-like petide-2 (GLP-2) has been widely adopted in treatment of short bowel syndrome (SBS), and the therapeutic benefits have been well documented, its effects after intestinal and multivisceral transplant are less documented. This study was designed to evaluate outcomes of GLP-2 therapy posttransplant.

Researchers conducted a retrospective, multicenter analysis of seven patients who received GLP-2 therapy following intestinal or multivisceral transplant between 2014-2024. Of the seven patients, two were male, five were female. The median age was 46 years old at time of transplant. Five underwent intestinal transplant and two received multivisceral transplants. Five patients developed short bowel syndrome due to bowel resection, and two patients had dysmotility.

At initiation, five patients were dependent on TPN. With GLP-2 therapy, three successfully transitioned off TPN. Therapy was discontinued in five patients, primarily due to bowel obstruction (three of five discontinuations). All seven patients retained their colon posttransplant, and no colon polyps or cancer was detected.

Implications

This is among the first studies to assess GLP-2 therapy in the post-intestinal transplant setting. The ability of approximately two-thirds of recipients to transition off TPN suggests that GLP-2 may help to facilitate nutritional autonomy and may be useful in posttransplant rehabilitation.

Read the full abstract.

Conclusion

UPMC Children’s contributions to CIIRTA 2025 demonstrate the institution’s leadership in the field of intestinal failure and transplantation. The three studies outline where current gaps remain in salvage after graft failure, accurate identification of intestinal-failure populations, and posttransplant rehabilitation strategies. These efforts reinforce UPMC’s commitment to advancing care, improving outcomes, and shaping future standards for intestinal transplant programs worldwide.