Center for Chronic Intestinal Failure, Department of Gastroenterology and Internal Medicine, University of Bologna, Italy.
Gut. 2011 Jan;60(1):17-25. doi: 10.1136/gut.2010.223255. Epub 2010 Nov 10.
The indications for intestinal transplantation (ITx) are still debated. Knowing survival rates and causes of death on home parenteral nutrition (HPN) will improve decisions.
A prospective 5-year study compared 389 non-candidates (no indication, no contraindication) and 156 candidates (indication, no contraindication) for ITx. Indications were: HPN failure (liver failure; multiple episodes of catheter-related venous thrombosis or sepsis; severe dehydration), high-risk underlying disease (intra-abdominal desmoids; congenital mucosal disorders; ultra-short bowel), high morbidity intestinal failure. Causes of death were defined as: HPN-related, underlying disease, or other cause.
The survival rate was 87% in non-candidates, 73% in candidates with HPN failure, 84% in those with high-risk underlying disease, 100% in those with high morbidity intestinal failure and 54%, in ITx recipients (one non-candidate and 21 candidates) (p<0.001). The primary cause of death on HPN was underlying disease-related in patients with HPN duration ≤2 years, and HPN-related in those on HPN duration >2 years (p=0.006). In candidates, the death HRs were increased in those with desmoids (7.1; 95% CI 2.5 to 20.5; p=0.003) or liver failure (3.4; 95% CI 1.6 to 7.3; p=0.002) compared to non-candidates. In deceased candidates, the indications for ITx were the causes of death in 92% of those with desmoids or liver failure, and in 38% of those with other indications (p=0.041). In candidates with catheter-related complications or ultra-short bowel, the survival rate was 83% in those who remained on HPN and 78% after ITx (p=0.767).
HPN is confirmed as the primary treatment for intestinal failure. Desmoids and HPN-related liver failure constitute indications for life-saving ITx. Catheter-related complications and ultra-short bowel might be indications for pre-emptive/rehabilitative ITx. In the early years after commencing HPN a life-saving ITx could be required for some patients at higher risk of death from their underlying disease.
肠移植（ITx）的适应证仍存在争议。了解接受家庭肠外营养（HPN）治疗患者的生存率和死亡原因将有助于决策。
前瞻性 5 年研究比较了 389 例非候选者（无适应证、无禁忌证）和 156 例候选者（适应证、无禁忌证）用于 ITx。适应证为：HPN 失败（肝功能衰竭；多次导管相关静脉血栓形成或脓毒症；严重脱水）、高危基础疾病（腹内纤维瘤；先天性黏膜疾病；极短肠）、高发病率肠衰竭。死亡原因定义为：HPN 相关、基础疾病或其他原因。
非候选者的生存率为 87%，HPN 失败的候选者为 73%，高危基础疾病的候选者为 84%，高发病率肠衰竭的候选者为 100%，接受 ITx 的患者为 54%（1 例非候选者和 21 例候选者）（p<0.001）。HPN 持续时间≤2 年的患者 HPN 相关的基础疾病是 HPN 相关死亡的主要原因，而 HPN 持续时间>2 年的患者 HPN 相关死亡的主要原因（p=0.006）。在候选者中，与非候选者相比，纤维瘤（7.1；95%CI 2.5 至 20.5；p=0.003）或肝功能衰竭（3.4；95%CI 1.6 至 7.3；p=0.002）患者的死亡风险比更高。在死亡的候选者中，92%的纤维瘤或肝功能衰竭患者以及 38%的其他适应证患者的 ITx 适应证为其死亡原因（p=0.041）。在发生导管相关并发症或极短肠的候选者中，继续接受 HPN 治疗的患者的生存率为 83%，接受 ITx 治疗的患者的生存率为 78%（p=0.767）。
HPN 被证实为肠衰竭的主要治疗方法。纤维瘤和 HPN 相关的肝功能衰竭构成了挽救生命的 ITx 的适应证。导管相关并发症和极短肠可能是预防性/康复性 ITx 的适应证。在开始 HPN 的早期，一些高危基础疾病患者可能需要进行挽救生命的 ITx。
