title: Safety and efficacy of home parenteral nutrition for chronic intestinal failure: a 16-year experience at a single centre.
abstract: BACKGROUND
  Comparisons between safety and efficacy of home parenteral nutrition and of intestinal transplantation for treatment of chronic intestinal failure derived from observational studies.
  
  
  OBJECTIVE
  To present the 16-year experience of home parenteral nutrition by the Chronic Intestinal Failure Centre of Bologna University.
  
  
  METHODS
  A total of 40 adult patients were enrolled between 1986 and 2001.
  
  
  METHODS
  Safety indices: survival and cause of death, catheter-related bloodstream infection, deep vein thrombosis, liver disease. Efficacy indices: nutritional and rehabilitation status, quality of life (SF36 instrument), re-hospitalisation rate.
  
  
  METHODS
  Kaplan-Maier analysis and Cox model for survival probability and risk factors; logistic regression for catheter-related bloodstream infection risk factors.
  
  
  RESULTS
  Survival rates at 1, 3 and 5 years were 97, 82 and 67% respectively. Survival was higher in patients < or = 40 years. One death was home parenteral nutrition-related. Incidence of catheter-related bloodstream infection: 0.30/year home parenteral nutrition, was lower in patients treated by a specialized nursing protocol. Incidence of deep vein thrombosis was 0.05/year home parenteral nutrition. Hepatosteatosis occurred in 55%. Body weight remained stable or increased in 80%. Rehabilitation was total or partial in 74%. Re-hospitalisation rate was 0.70/year home parenteral nutrition. Quality of life scored significantly lower than in healthy populations in six out of eight domains.
  
  
  CONCLUSIONS
  Home parenteral nutrition is a safe and efficacious therapy for chronic intestinal failure. Survival compares favourably with survival after intestinal transplantation.
authors.affiliation: Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy. loris.pironi@med.unibo.it
authors.forename: L
authors.initials: L
authors.lastname: Pironi
authors.forename: F
authors.initials: F
authors.lastname: Paganelli
authors.forename: A M M
authors.initials: AM
authors.lastname: Labate
authors.forename: C
authors.initials: C
authors.lastname: Merli
authors.forename: C
authors.initials: C
authors.lastname: Guidetti
authors.forename: G
authors.initials: G
authors.lastname: Spinucci
authors.forename: M
authors.initials: M
authors.lastname: Miglioli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D016331:Parenteral Nutrition, Home; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome