Outcomes of referral for intestinal transplantation at the Scandinavian referral centre: indications, reasons for non-listing, and survival.

BACKGROUND: Patient selection is central to optimizing outcomes after intestinal transplantation (ITx). Over the past decade, viable intestinal rehabilitation strategies, including autologous intestinal reconstructive surgery, enterohormone therapies, and interventional radiology, have expanded non-transplant options and altered referral patterns. Yet acceptance rates and reasons for non-listing remain poorly characterized. METHODS: We retrospectively reviewed all adult ITx referrals at a comprehensive intestinal rehabilitation and transplant centre between January 2018 and December 2025, examining multidisciplinary team decisions, reasons for non-listing, patient characteristics, and use of non-transplant modalities. RESULTS: Of 55 referred adults, 9 (16%) were transplanted and 46 (84%) were not listed. Groups did not differ significantly in age (median 49 vs 44 years, p = 0.24), sex (52% vs 66% male, p = 0.54), parenteral support-dependence (56% vs 66%, p = 0.82), or comorbidity burden (median CCI 2 vs 3, p = 0.77). The predominant reason for non-listing was absence of current indication (41%), followed by 'too early' assessment (34%) and contraindications (21%). Notably, 6/9 (67%) patients ultimately transplanted were initially deemed 'too early'. Non-transplant alternatives were identified in 72% of non-listed patients, primarily medical optimization (46%) and interventional radiology (37%). One-year survival was comparable between non-listed (81%) and transplanted (78%, p = 0.95) patients. CONCLUSIONS: In the era of effective non-transplant therapies, most referrals were managed without ITx. A dynamic, individualized approach emphasizing reassessment identifies patients for whom transplantation offers the greatest benefit while avoiding unnecessary early listing.