Survival and dependence on home parenteral nutrition: experience over a 25‐year period in a UK referral centre

Lloyd, David; Vega, R. Mailhot; Bassett, Paul; Forbes, Alastair; Gabe, Simon

doi:10.1111/j.1365-2036.2006.03106.x

Cited by 136 publications

(109 citation statements)

References 24 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%

“…46 CVC-related sepsis rates have recently been variably reported as 0.14-0.83 episodes/patient-year. [47][48][49][50][51] As outlined above, maintaining low sepsis rates requires careful catheter care protocols, with multiple studies reiterating the importance of a multidisciplinary nutrition support team in reducing CVC-related sepsis. 45,[52][53][54] The patient is key to minimising CVC-related sepsis rates at home.…”

Section: Complications Of Long-term Pnmentioning

confidence: 99%

“…46,48,49,83,152,[156][157][158] Survival is principally determined by underlying disease; patients with inflammatory bowel disease for example demonstrate a high 5-year survival of 92%, 157 whereas patients with motility disorders have the poorest 5-year survival at 48%. 157 Multivariate analysis of survival data from single centres has also demonstrated lower survival rates in patients with end-enterostomies 156,158 or a small bowel length of <50 cm.…”

Section: Survivalmentioning

confidence: 99%

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Review article: the management of long‐term parenteral nutrition

Dibb

Teubner

Theis

et al. 2013

Aliment Pharmacol Ther

137

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%

Section: Complications Of Long-term Pnmentioning

confidence: 99%

Section: Survivalmentioning

confidence: 99%

See 1 more Smart Citation

Review article: the management of long‐term parenteral nutrition

Dibb

Teubner

Theis

et al. 2013

Aliment Pharmacol Ther

137

108

View full text Add to dashboard Cite

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“…4% of established HPN cases in 2009 (6) . Fortunately, patients with Crohn's disease have the best prognosis of all disease groups once type 3 IF is established, with a 5-year survival on HPN of 87-92 % (35,36) .…”

Section: Outcome Of Intestinal Failure In Crohn's Diseasementioning

confidence: 99%

Approaches to intestinal failure in Crohn's disease

Calvert

Lal

2011

Proc. Nutr. Soc.

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Crohn's disease is one of the leading causes of intestinal failure. The term ‘type 2’ intestinal failure is used to describe the relatively rare type of intestinal failure that occurs in association with septic, metabolic and complex nutritional complications, typically following surgical resection and/or laparostomy for intra-abdominal sepsis. A multidisciplinary approach to the management of patients with type 2 intestinal failure is crucial, and it is helpful to approach patient care in a structured manner using the ‘sepsis-nutrition-anatomy-plan’ algorithm: resolution ofsepsis is required before adequate nutritional repletion can be achieved, and it is crucial to optimise nutritional status, and define intestinal anatomy before delineating a definitive medical or surgical plan. A structured approach to the management of patients with inflammatory bowel disease, who have developed type 2 intestinal failure, should reduce the likelihood of these patients developing ‘type 3’ intestinal failure, which is characterised by the need for long-term parenteral nutrition. However, Crohn's disease is still the commonest indication for home parenteral nutrition in the UK.

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“…Currently, it is certainly not possible to advise all PN patients that SIT will improve their length of life; indeed, overall the opposite is probably the reality. If all those individuals currently on PN were transplanted there would be an overall reduction in longevity (Grant et al 2005;Jones et al 2005;Lloyd et al 2006). However, certain patients would benefit, and not only experience a dramatic improvement in length of life but also a transformation in the quality of their lives Rovera et al 1998;Goulet et al 1999;Cameron et al 2002).…”

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confidence: 99%

Is intestinal transplantation now an alternative to home parenteral nutrition?

Middleton

2007

Proc. Nutr. Soc.

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Patients with irreversible intestinal failure and complications of parenteral nutrition should now be routinely considered for small intestine transplantation. Despite attempts for > 40 years immunological graft intolerance presented an impenetrable barrier to successful engraftment until the development in the late 1970s of the powerful calcineurin-inhibitor immunosuppressive agents. Their use over the last 17 years has led to small intestinal transplantation being generally considered as a routine option for patients with irreversible intestinal failure and failing parenteral nutrition. The 1-year patient survival rates ( %) are now excellent for renal (95), liver (78), heart (82) and lung (75) transplantation. In contrast, survival rates for small intestinal transplantation have been slow to improve, although they are now approaching those for lung and liver transplantation (intestine 78 %, intestine and liver 60 %, multivisceral 66 %), and well-performing centres report recent 1-year graft survival rates as high as 92 %. Patient 5-year survival ( %) has also improved (intestine alone 50, intestine and liver 50 and multivisceral 62) and compares increasingly favourably with renal (85), liver (67), heart (67) and lung (46). Currently, small intestinal transplantation is reserved for patients with irreversible small intestinal failure who have a poor prognosis on parenteral nutrition. However, as 5-year patient survival following intestinal transplantation approaches that for parenteral nutrition there will be increasing pressure to offer this modality of treatment as an alternative to parenteral nutrition, especially for those patients who have a poor quality of life as a result of parenteral nutrition. Parenteral nutrition: Small intestinal transplantation: Risk assessment: Survival:Intestinal failureThe short answer to this now frequently-asked question is yes, but only for certain patients in certain circumstances. Perhaps as a consequence of the exponential rise in the sophistication of medical treatments, patients with catastrophic loss of the small intestine, at least in the developed countries, are no longer treated in a palliative manner and are now offered salvage surgery and parenteral nutrition (PN) as a routine. The main concern in the art of intravenous feeding is getting the simple aspects consistently correct and paying attention to detail. It is a highly-skilled practice and is well established in the UK because of a relatively small number of dedicated clinicians. It is not, however, easily accessed by some patients in geographically-remote regions, and this lack of accessibility is currently the subject of much interest and debate. When used prudently and with care PN allows patients to have a good quality and length of life (Baxter et al. 2006). Given this good profile of PN, why take the added risks of small intestinal transplantation (SIT)? From the patient's perspective life without dependency on the intravenous infusion of water and nutrients, often daily over 8 h, is very attractive as ...

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Survival and dependence on home parenteral nutrition: experience over a 25‐year period in a UK referral centre

Abstract: SUMMARY BackgroundHome parenteral nutrition (HPN) is the standard treatment for severe intestinal failure in the United Kingdom.

Cited by 136 publications

References 24 publications

Review article: the management of long‐term parenteral nutrition

Review article: the management of long‐term parenteral nutrition

Approaches to intestinal failure in Crohn's disease

Is intestinal transplantation now an alternative to home parenteral nutrition?

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