The follow-up after intestinal transplantation (ITX) is complex and limited to specialized centers. ITX recipients often travel all over the country to be seen in the outpatient clinic of specialized centers which is costly and time-consuming. Videoconferences through Skype have been implemented to eliminate travel time, costs, and to improve patient compliance without jeopardizing safety. Eighteen of 19 patients followed up after ITX or modified multivisceral transplantation (MMVTX) in conventional outpatient clinics in Oxford agreed to attend additional Skype clinics. All patients who were followed up through Skype clinics after ITX/MMVTX received a questionnaire to measure their satisfaction with methods and technical aspects of videoconferencing as well as time/mode of traveling, travel expenses/costs, waiting time in outpatient clinic and patients' satisfaction. Mean travel distance to Oxford was 236 ± 168 miles, mean travel time was 277 ± 175 min, and mean travel cost was 200 ± 56 Great Britain Pounds. A total of 56% had to take time off work and/or find child/family care for the time spent in travel. These patients reported a satisfaction score of 4.38 ± 0.77 of 5 points as opposed to 2.88 ± 0.90 for attending the conventional outpatient clinic. Skype clinics have been proven successful and feasible in highly specialized fields like ITX in eligible patients.

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IntroductionIntestinal failure (IF) and intestinal transplant (ITx) are associated with poor quality of life (QoL).Disease-specific assessment of QoL for IF and ITx is challenging, owing to the different problems encountered. We have sought to compare QoL pre-ITx with post-ITx and have compared generic QoL with a stable IF population. MethodsTwo prospectively maintained databases of patients referred for and undergoing ITx and a chronic (Type 2 & 3) IF cohort were interrogated. QoL instruments used were generic (EQ-5D-5L and SF-36) and disease-specific (HPN-QOL and ITx-QOL). Analysis used Student's t-test and one-way ANOVA with Bonferroni correction for multiple comparisons. Data were collected pre-and post-ITx at 3, 6, 12-months and yearly thereafter. ResultsAll QoL instruments improved following ITx to levels comparable with a cohort of stable IF patients not requiring ITx. Both the visual analogue score component (EQ-5D-5L) and the effect of underlying illness on QoL (HPN-QOL/ITx-QOL) were higher following ITx than either pre-ITx or when compared with the IF cohort. Effects on general health, ability to eat and drink, to holiday and travel were improved as early as 3 months post-ITx. Other components did not before 6-12 months following ITx, but were maintained to at least 24 months. Patient personal financial pressures are greater following ITx, even in a publically funded healthcare system. ConclusionITx has beneficial effects on QoL compared to those assessed for or awaiting ITx. QoL following ITx is similar to patients with IF not requiring ITx. A QoL instrument that covers the journey of patients from IF through ITx would assist longitudinal analysis of the value and timing of ITx at an individual level.

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IntroductionSmall bowel intestinal transplantation is provided for patients with intestinal failure for whom complications, among other reasons, such as intestinal failure associated liver disease (IFALD), multiple central venous catheter (CVC) infections, loss of venous access or who have intra-abdominal desmoids. In addition, within the American guidelines is quality of life (QoL). There is no robust QoL data collection tool to compared patients undergoing small bowel transplantation compared to those remaining on parenteral nutrition (PN).MethodsData of all patients undergoing small bowel transplant in Oxford, one of the 2 national adult small bowel transplant centres in the UK, are captured on a prospectively entered database. QoL data was recorded using patient related outcome measures (PROM) and using EQ5D both pre and post intestinal transplant. Data was audited in January 2016. The Oxford Intestinal Failure (IF) cohort also had QoL data recorded and was used as a comparator.ResultsPROM measurements include survival where out of 29 transplants that had occurred, 19 were alive (66%), 1 (5%) was on TPN as an inpatient and 2 (11%) were on home iv fluids, 16 (84%) were on no TPN, iv fluids or tube enteral nutrition support.Questionnaire data utilised the visual analogue scale part of the EQ5D as a global rating scale for the patients to record their assessment of QoL. It was recorded as median (range) for 4 patients who completed questionnaires pre and post transplant giving 4 pre results and 7 post results; pre-transplant 17.5 (10–30) and post-transplant 79.5 (60–85). 4 patients had only filled in pre-transplant questionnaires: 35 (10–50), which included 1 patient who died post-transplant, 2 patients at their assessment and 1 who was post-explant of their graft for chronic rejection and are listed for retransplantation. In addition, 5 patients completed post-transplant questionnaires on 7 occasions 80 (55–90). This compares to the Oxford IF cohort of whom 30 patients filled in a questionnaire on 1 occasion, 15 on a 2nd at a median of 5 months (1–15) following the first and 3 on a 3rd occasion at 4 months (3–5) after the second. The median (range) for the Oxford IF cohort was 62.5 (25–100), 65 (30–100), 75 (60–85).ConclusionFrom this preliminary series, small bowel transplantation does improve quality of life post-transplant compared to pre-transplant. The level post-transplant is better than that experienced by patients on home PN. A better QoL data tool is required to effectively assess patients undergoing small bowel intestinal transplantation that can be effectively compared to patients who remain on PN.Disclosure of InterestV. Blackwell: None Declared, L. Holdaway: None Declared, S. Travis: None Declared, S. Reddy: None Declared, G. Vrakas: None Declared, A. Smith: None Declared, A. Vaidya: None Declared, P. Friend: None Declared, P. Allan Consultant for: Abbvie, Conflict with: BresMed advisor; NPS Pharma educational grant