Survival of patients identified as candidates for intestinal transplantation: a 3-year prospective follow-up.
OBJECTIVE
The US Medicare indications for intestinal transplantation are based on failure of home parenteral nutrition. The American Society of Transplantation also includes patients at high risk of death from their primary disease or with high morbidity intestinal failure. A 3-year prospective study evaluated the appropriateness of these indications.


METHODS
Survival on home parenteral nutrition or after transplantation was analyzed in 153 (97 adult, 56 pediatric) candidates for transplantation and 320 (262 adult, 58 pediatric) noncandidates, enrolled through a European multicenter cross-sectional survey performed in 2004. Kaplan-Meier and chi-square test statistics were used.


RESULTS
The 3-year survival was 94% (95% CI, 92%-97%) in noncandidates and 87% (95% CI, 81%-93%) in candidates not receiving transplants (P = .007). Survival was 80% (95% CI, 70%-89%), 93% (95% CI, 86%-100%), and 100% in parenteral nutrition failure, high-risk primary disease, and high-morbidity intestinal failure, respectively (P = .034). Fifteen candidates underwent transplantation. Six died, including all 3 of those who were in hospital, and 25% of those who were at home at time of transplantation (P = .086). Survival in the 10 patients receiving a first isolated small bowel transplant was 89% (95% CI, 70%-100%), compared with 85% (95% CI, 74%-96%) in the candidates with parenteral nutrition failure not receiving transplants because of central venous catheter complications, or 70% (95% CI, 53%-88%) in those with parenteral nutrition-related liver failure (P = .364).


CONCLUSIONS
The results confirm home parenteral nutrition as the primary therapeutic option for intestinal failure and support the appropriateness and potential life-saving role of timely intestinal transplantation for patients with parenteral nutrition failure.
Pironi
Loris
L
Department of Clinical Medicine, University of Bologna, Italy. loris.pironi@unibo.it
Forbes
Alastair
A
Joly
Francisca
F
Colomb
Virginie
V
Lyszkowska
Malgorzata
M
Van Gossum
André
A
Baxter
Janet
J
Thul
Paul
P
Hébuterne
Xavier
X
Gambarara
Manuela
M
Gottrand
Frederic
F
Moreno Villares
José M
JM
Messing
Bernard
B
Goulet
Olivier
O
Staun
Michael
M
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000178:diet therapy / Q000401:mortality* / Q000601:surgery; D006801:Humans; D007422:Intestines / Q000637:transplantation*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000401:mortality*; D018579:Patient Selection; D011446:Prospective Studies; D014180:Transplantation / Q000401:mortality*