ADULT PATIENTS RECEIVING HOME PARENTERAL-NUTRITION IN DENMARK FROM 1991 TO 1996 - WHO WILL BENEFIT FROM INTESTINAL TRANSPLANTATION

Background: Small-bowel transplantation is an alternative to home pare nteral nutrition (HPN) in patients with gut failure. Our aim was to re port the indication, diagnosis, morbidity, mortality, and intestinal a daptation in the total cohort of Danish patients receiving HPN at any time during the 5 years between 1 January 1991 and 31 December 1995. T he data were analysed against the option of transplantation. Results: HPN was given to 129 patients; 59 (46%) had inflammatory bowel disease (15% died), 26 (20%) had cured cancers (42% died), and 44 (34%) had o ther diseases (dysmotility, surgical complications, infarcts, and so f orth; 27% died). Of these, 60% were new in the HPN program, but only 1 9% received HPN all 5 years; 31% had terminated HPN, 19% permanently, and 25% died. Only four deaths were HPN-related. In December 1995, 73 patients were receiving HPN in Denmark, for a prevalence of 13.9 per m illion, which is the highest in Europe but 10-fold lower than in the U nited States. Conclusions: Gut failure was the only indication for HPN in Denmark. Weight loss without gut failure, such as disseminated can cer and acquired immunodeficiency syndrome, was not an indication for HPN. Survival after small-bowel transplantation should be assessed aga inst a sizeable mortality among candidates receiving HPN, and this dep ends on diagnosis and age. In an HPN population comparable with the Da nish, a quarter is likely to die within a period of 5 years, a quarter will terminate HPN, and the others survive with HPN. Small-bowel tran splantation can be a lifesaving procedure in the small fraction of for eseeable HPN-related deaths, mainly caused by liver failure. Transplan tation will not improve survival in most adult HPN patients, and only an improved quality of life after transplantation justifies this proce dure in most HPN patients.