Candidates for intestinal transplantation: a multicenter survey in Europe.
OBJECTIVE
Epidemiology of candidacy for intestinal transplantation (ITx) and timing for referral for ITx are unknown. Patient candidacy and physician attitudes toward ITx were investigated among centers that participated in previous European surveys on home parenteral nutrition (HPN).


METHODS
Patients on HPN for benign intestinal failure (IF) were evaluated by a structured questionnaire. Candidacy was assessed by USA Medicare and American Transplantation Society criteria, categorized as: (1) life-threatening HPN complications; (2) high risk of death because of the gastrointestinal disease; (3) IF with high morbidity or patient HPN refusal. Physicians judged candidacy as immediate or potential.


RESULTS
Forty-one centers from nine countries enrolled 688 adults (> 18 yr) and 166 pediatric patients; 70% of patients were from five countries which collected 60-100% of their HPN patients. Candidacy was 15.7% in adults and 34.3% in pediatrics (HPN failure, 62.1% and 28.1%; gastrointestinal disease, 25.9% and 59.6%; high morbidity IF or HPN refusal, 12.0% and 12.3%, respectively). Immediate candidacy was required for 14.8% of adult and 15.8% of pediatric candidates (< 50% of candidates because of HPN-related liver failure). Among centers, the candidacy rate ranged 0-100% and was negatively associated with the number of patients enrolled in the survey (R = -0.463, p = 0.002). Among the major contributing countries, candidacy ranged 0.3-0.8/million inhabitants for adults and 0.9-2/million inhabitants < or = 18 yr for pediatric candidates.


CONCLUSIONS
The rate of candidacy and the indications for ITx candidacy differed greatly among age groups and HPN centers; within countries candidacy was more homogeneous; physicians had a generally reserved attitude toward ITx.
Pironi
Loris
L
Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy.
Hébuterne
Xavier
X
Van Gossum
Andre
A
Messing
Bernard
B
Lyszkowska
Malgorzata
M
Colomb
Virginie
V
Forbes
Alastair
A
Micklewright
Ann
A
Villares
Jose Manuel Moreno
JM
Thul
Paul
P
Bozzetti
Federico
F
Goulet
Olivier
O
Staun
Michael
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D005060:Europe; D005260:Female; D006801:Humans; D007223:Infant; D007422:Intestines / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition; D018579:Patient Selection; D012017:Referral and Consultation; D011795:Surveys and Questionnaires