Management of intestinal failure in inflammatory bowel disease: Small intestinal transplantation or home parenteral nutrition?

Table 1 Intestinal transplantation indications[53,57,92,94]

North American	European
Indications	Indication
Failure of home parenteral nutrition (HPN)	Irreversible, benign, chronic intestinal failure with no possibility of bowel rehabilitation associated with life threatening complications of HPN
Impending or overt liver failure
Central venous thrombosis of ≥ 2 central veins	Individual case-by-case decision for all patients
Frequent and severe central venous catheter-related sepsis
Frequent episodes of severe dehydration despite intravenous fluids in addition to HPN	Non-indications
	High risk of death due to underlying disease
High risk of death attributable to the underlying disease	Chronic dehydration
Intra-abdominal invasive desmoids tumour	Significantly impaired quality of life
Congenital mucosal disorders
Ultra-short bowel syndrome
Intestinal failure with high morbidity and low acceptance of HPN
Need for frequent hospitalisation, narcotic addiction or inability to function
Patient’s unwillingness to accept long-term HPN

Table 2 Comparison of patient survival

		1-yr	3-yr	5-yr	10-yr
Home parenteral nutrition	Series of 40 patients excluding malignancy (1986-2001)[31]	97%		82%	67%
	Series of 268 patients with SBS and excluding malignancy (1990-2006)[30]	94%		70%	52%
	Patients with Crohn's disease (CD) extracted from multiple series[34]				88%
	Series of 60 patients with CD (1979-2003)[33]			87%
Intestinal transplantation	Series of 453 patients (1990-2008)[39]	85%		61%	42%
	Series of 687 patients (1987-2009)[37]	77%	61%	51%
	Series of 86 patients with CD (1987-2009)[24]	79%	53%	43%

Table 3 Potential complications of home parenteral nutrition and intestinal transplantation

Home parenteral nutrition	Intestinal transplantation
Catheter-related blood stream infection	Allograft rejection
Catheter-related central venous thrombosis	Infection
Intestinal failure-associated liver disease	Graft vs host disease
	Post-transplant lymphoproliferative disease
	Renal failure
	Disease recurrence