Outcome on home parenteral nutrition for benign intestinal failure: a review of the literature and benchmarking with the European prospective survey of ESPEN.
OBJECTIVE
Indications and timing for referral for intestinal transplantation (ITx) were investigated through a review of the literature on home parenteral nutrition (HPN) for benign intestinal failure and a benchmarking to the results of a prospective European survey which evaluated the appropriateness of the current indications for ITx.


METHODS
Manuscripts reporting outcomes of adults and children on HPN were retrieved through a PubMed search. Data from the European survey were compared with those on HPN reported in the literature, and with those on ITx reported by the USA registry and by the Pittsburgh center.


RESULTS
HPN is a safe treatment with a high probability of survival. The risk of death during HPN is increased by the absence of a specialist team, and appears greater during the early period of treatment. Survival probability is decreased in patients with: age >40 or <2 years, very short bowel remnant, presence of a stoma, chronic intestinal pseudo-obstruction of myopathic origin, systemic sclerosis, radiation enteritis, intra-abdominal desmoids, necrotizing enterocolitis, congenital mucosal diseases. Liver failure is the HPN-related complication with the greatest risk of death. Death related to venous catheter complications is rare. The benchmarking supported the results of the European survey.
Center for Chronic Intestinal Failure, Department of Gastroenterology and Internal Medicine, St. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy. loris.pironi@unibo.it
Loris
L
Pironi
Olivier
O
Goulet
Alan
A
Buchman
Bernard
B
Messing
Simon
S
Gabe
Manila
M
Candusso
Geoffrey
G
Bond
Girish
G
Gupte
Marek
M
Pertkiewicz
Ezra
E
Steiger
Alastair
A
Forbes
Andrè
A
Van Gossum
Antonio Daniele
AD
Pinna
D019985:Benchmarking; D003625:Data Collection; D016208:Databases, Factual; D005060:Europe; D006801:Humans; D007410:Intestinal Diseases / Q000401:mortality / Q000628:therapy*; D007422:Intestines / Q000503:physiopathology*; D016331:Parenteral Nutrition, Home / Q000009:adverse effects; D011336:Probability; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome