The Italian need for intestinal transplantation

Abstract

The introduction of total parenteral nutrition in 1968 by Dudrik for the cure of patients with intestinal failure opened a new horizon of life support for patients once considered to have an end-stage prognosis. Small bowel transplantation (SBT) is currently restricted to patients with end-stage intestinal failure on life-saving long-term parenteral nutrition. Until now SBT has been an alternative to long-term home parenteral nutrition (HPN) only for patients with irreversible intestinal failure and for those with intolerance to HPN or for whom HPN was impossible. The Italian HPN Register enrolls adult patients on HPN, who could be considered potential candidates for SBT under criteria accepted in the literature (no malignant diseases or human immunodeficiency virus infection, age less than 60 years, irreversible end-stage intestinal failure, duration of HPN, loss of vascular access) (Fig 1). Nevertheless, the Italian HPN Register reveals the following issues. The centers and patients are not homogeneously spread throughout Italy; HPN is not regulated by national law or subsidized by the national health service (possibility of missing patients); and the anatomic, clinical, psychological, and environmental conditions of every patient are not sufficiently documented. For these reasons, the number of candidates for SBT could be under- or overestimated and not representative of the population. To avoid this misunderstanding, we considered our series in the Piemonte Region where our unit is the reference point for the HPN patients of our region; HPN has been regulated and subsidized by regional law since 1985; and the territory and inhabitants are known. Therefore, our center could be a representative model of the Italian HPN population. We can assume from the Piemonte HPN Register an estimate of the number of SBT adult candidates in the Italian population. The aim of our retrospective study was to evaluate the historical collection of adult patients on HPN from our Piemonte HPN Register and establish which of these patients might be suitable candidates for transplantation.