Long-term follow-up of patients on home parenteral nutrition in Europe: implications for intestinal transplantation

Pironi, Loris; Joly, Francisca; Forbes, Alastair; Colomb, V.; Łyszkowska, M.; Baxter, J.; Gabe, Simon; Hébuterne, Xavier; Gambarara, M.; Gottrand, Frédéric; Cuerda, C.; Thul, P.; Messing, Bernard; Goulet, Olivier; Staun, Michael; Gossum, A. Van

doi:10.1136/gut.2010.223255

Cited by 251 publications

(178 citation statements)

References 26 publications

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“…48,157 Deaths related to the underlying disease tend to occur during the first 2 years of treatment, whereas HPN-related deaths often occur after this. 160 …”

Section: Survivalmentioning

confidence: 99%

Review article: the management of long‐term parenteral nutrition

Dibb

Teubner

Theis

et al. 2013

Aliment Pharmacol Ther

134

108

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SummaryBackgroundHome parenteral nutrition (HPN) is currently the management of choice for patients with chronic intestinal failure.AimTo summarise the major issues in delivering long‐term parenteral nutrition (>3 months) and assess outcome as per complications, mortality and quality of life. To assess the evidence for the therapeutic use of trophic factors such as teduglutide and to review evolving therapeutic options in the treatment of chronic intestinal failure.MethodsA literature search using PubMed and MEDLINE databases was performed.ResultsSafe delivery of HPN relies upon individualised formulations of parenteral nutrition administered via carefully maintained central venous catheters by trained patients or carers, supported by a skilled multidisciplinary team. Early diagnosis and treatment of complications including catheter‐associated blood stream infection (reported incidence 0.14–0.83 episodes/patient‐year on HPN) and central venous thrombosis (reported incidence 0.03 episodes/patient‐year) is important to minimise mortality and morbidity. There is a significant variation in the reported incidence of both hepatobiliary complications (19–75%) and advanced liver disease (0–50%). Five‐year survival rates in large centres are reported between 60% and 78% with survival primarily related to underlying diagnosis. Long‐term survival remains higher on HPN than with intestinal transplantation. The role of intestinal lengthening procedures is yet to be validated in adults.ConclusionsHome parenteral nutrition delivered by skilled nutrition teams has low incidences of catheter‐related complications. Most deaths relate to the underlying disease. Therapies such as teduglutide and small bowel transplantation appear promising, but home parenteral nutrition appears likely to remain the bedrock of management in the near term.

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“…48,157 Deaths related to the underlying disease tend to occur during the first 2 years of treatment, whereas HPN-related deaths often occur after this. 160 …”

Section: Survivalmentioning

confidence: 99%

Review article: the management of long‐term parenteral nutrition

Dibb

Teubner

Theis

et al. 2013

Aliment Pharmacol Ther

134

108

View full text Add to dashboard Cite

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“…This condition is often associated with expansion of extracellular water volume, and an overzealous administration of glucose may easily precipitate a peritoneal effusion which consequently forces withdrawal of the intravenous nutrition (74).…”

Section: Drug Treatmentmentioning

confidence: 99%

New perspective for nutritional support of cancer patients: Enteral/parenteral nutrition

Akbulut

2011

Experimental and Therapeutic Medicine

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“…Historically, life-threatening complications and the underlying disease led to mortality of up to 38% within 2-5 years following the development of intestinal failure (3)(4)(5)(6). In a contemporary series, for patients without complications marked improvement in survival was demonstrated with 87% of PN-dependent patients achieving 5-year patient survival (7). Despite these medical advances however, contemporary multi-center studies suggest 19-26% of patients that are permanently PN dependent develop severe complications and are therefore considered to have indications for intestine transplantation (6,7).…”

Section: Purpose Of Reviewmentioning

confidence: 99%

“…In a contemporary series, for patients without complications marked improvement in survival was demonstrated with 87% of PN-dependent patients achieving 5-year patient survival (7). Despite these medical advances however, contemporary multi-center studies suggest 19-26% of patients that are permanently PN dependent develop severe complications and are therefore considered to have indications for intestine transplantation (6,7). Further, in adults, 5-year patient survival for the subgroup of patients with home PN failure (complications that are considered indications for intestine transplantation) was 73% and the majority of deaths were related to home PN in patients PN dependent for greater than 2 years (7).…”

Section: Purpose Of Reviewmentioning

confidence: 99%

“…Although the Centers for Medicare & Medicaid Services in April 2001 approved coverage of intestine or multi-visceral transplantation for patients with these complications of intestine failure (14), recurrent life-threatening sepsis has recently been challenged as an indication (15). Subsequently, others have suggested additional indications including patients with ultra-short remnant bowel lengths (<10 cm in children and <20 cm in adults), porto-mesenteric venous thrombosis, slow growing central abdominal tumors involving the mesenteric root (such as desmoids tumors or neuroendocrine tumors), pseudoobstruction and frozen abdomen (7,(16)(17)(18).…”

Section: Indicationsmentioning

confidence: 99%

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The Current State of Intestine Transplantation: Indications, Techniques, Outcomes and Challenges

Sudan

2014

American Journal of Transplantation

110

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Intestine transplantation is the least common form of organ transplantation in the United States and often deemed one of the most difficult. Patient and graft survival have historically trailed well behind other organ transplants. Over the past 5-10 years registry reports and single center series have demonstrated improvements to patient survival after intestinal transplantation that now match patient survival for those without life-threatening complications on parenteral nutrition. For various reasons including improvements in medical care of patients with intestinal failure and difficulty accessing transplant care, the actual number of intestine transplants has declined by 25% over the past 6 years. In light of the small numbers of intestine transplants, many physicians and the lay public are often unaware that this is a therapeutic option. The aim of this review is to describe the current indications, outcomes and advances in the field of intestine transplantation and to explore concerns over future access to this important and life-saving therapy.

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Long-term follow-up of patients on home parenteral nutrition in Europe: implications for intestinal transplantation

Cited by 251 publications

References 26 publications

Review article: the management of long‐term parenteral nutrition

Review article: the management of long‐term parenteral nutrition

New perspective for nutritional support of cancer patients: Enteral/parenteral nutrition

The Current State of Intestine Transplantation: Indications, Techniques, Outcomes and Challenges

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