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Quality of life on long-term parenteral nutrition

can it be an indication for intestinal transplantation?

Avitzur, Yaron*; Miserachs, Mar*

Current Opinion in Organ Transplantation: April 2018 - Volume 23 - Issue 2 - p 199–206
doi: 10.1097/MOT.0000000000000503
SMALL BOWEL TRANSPLANTATION: Edited by Florence Lacaille
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Purpose of review Long-term outcomes in patients with intestinal failure and following intestine transplantation have improved significantly over the last decade. With these improvements, listing criteria for intestine transplantation are reevaluated and the role of quality of life (QoL) in patients’ outcome is increasingly studied and emphasized. Here, we review the recent literature on QoL before and after intestine transplantation and discuss whether QoL should be considered as a listing criterion for intestine transplantation.

Recent findings Patients on home parenteral nutrition, experience lower QoL compared with healthy population and equal or lower QoL than patients with other chronic diseases. After transplantation, QoL improves and is comparable in some QoL domains to that of the general population. These findings are limited by heterogeneous study designs and sample size. Although QoL improves after intestine transplantation, long-term survival of patients receiving HPN surpass postintestine transplantation survival. Poor QoL is not associated with an increased mortality in patients receiving HPN.

Summary Current survival outcomes of intestine transplantation do not justify poor QoL as a single listing criterion for intestine transplantation. However, intestine transplantation should be considered in patients with unique circumstances of extremely poor QoL. This approach may change once postintestine transplantation patient survival will further improve.

Division of Pediatric Gastroenterology, Hepatology and Nutrition, Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

Correspondence to Yaron Avitzur, MD, Division of Pediatric Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada. Tel: +1 416 813 6176; fax: +1 416 813 4972; e-mail: yaron.avitzur@sickkids.ca

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