Home parenteral nutrition ‘treatment of choice’ for intestinal failure
MedWire News: Home parenteral nutrition (HPN) is confirmed as the treatment of choice for the majority of patients with intestinal failure, with only a small group of patients requiring intestinal transplantation, report researchers.
Patients with irreversible intestinal failure currently have HPN as a first port of call and then potentially intestinal transplantation. As the latter requires major, high-risk surgery, the indications for such transplantation are still debated, say Loris Pironi (University of Bologna, Italy) and colleagues.
To investigate further, they carried out a prospective 5-year study of 389 patients on HPN with no indications or contraindications for intestinal transplantation (noncandidates) and 156 HPN-treated patients with indications, but no contraindications for intestinal transplantation (candidates). Such indications included HPN failure, high-risk underlying disease such as intra-abdominal desmoids, and high morbidity intestinal failure.
As reported in the journal Gut, the team found that survival rates at study completion were 87%, 73%, 84%, and 100% in non-candidates, candidates with HPN failure, those with high-risk underlying disease, and those with high morbidity intestinal failure, respectively. Of those who had intestinal transplantation (21 candidates, 1 noncandidate), 54% survived.
Death was primarily related to underlying disease in patients who had been on HPN for 2 years or less and was related to HPN only in patients with a duration of HPN of more than 2 years.
Presence of desmoids or liver failure increased the risk for death by 7.1 and 3.4 fold, respectively, in patients who were candidates, suggesting that these are likely to be good indications for early referral for intestinal transplantation.
"In agreement with previous results, in patients clinically stable on HPN, survival probability was greater and treatment-related death was less likely than that in intestinal transplant recipients," conclude the authors.
They say: "HPN is confirmed as the treatment of choice for intestinal failure."
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By Helen Albert