2017 - CIRTA


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2- Nutrition Management and Total Parenteral Nutrition

18.12 - Long Term Home Parenteral Nutrition Versus Intestinal Transplantation: evolution

Presenter: Catherine, Poisson, Paris, France
Authors: Hafsa Fezaa, Catherine Poisson, Cecile Lambe, Carmen Capito, Christophe Chardot, Florence Lacaille, Olivier Goulet

Long Term Home Parenteral Nutrition Versus Intestinal Transplantation: evolution

Hafsa Fezaa1, Catherine Poisson1, Cecile Lambe1, Carmen Capito1, Christophe Chardot1, Florence Lacaille1, Olivier Goulet1.

1Gastroenterology-Hepatology-Nutrition, Hôpital Necker-Enfants Malades, Paris, France

Long term home parenteral nutrition (HPN) and intestinal transplantation (ITx) are the 2 treatments of total and definitive intestinal failure.

HPN is performed from 1984 in our hospital. More than 800 children were included in the program from its beginning. In 2016, 136 children, 60% with total and definitive intestinal failure, were on HPN.  

Our hospital is also the only pediatric center ITx in France. From 1994, 103 children received 113 ITx. Mean age at ITx was 5 years. Indications for ITx have decreased in the last 5 years, with only one or two ITx per year from 2013. One patient only was on the waiting list in 2017.

ITx is nowadays proposed when severe complications of HPN arise only, such as severe liver or kidney disease. Duration of HPN, social difficulties, infections, problems with venous access, are no longer a definite indication for ITx.

In the last 5 years, we observed:
-    a decrease in infections due to the use of taurolidine, and an agressive program of patient’s education.
-    a systematic and larger evaluation of the possibilities for HPN.
-    a better adaptation to social and familial difficulties.

With case reports, we will describe how HPN is nearly always possible, by pushing the limits but without excessive risks, and with a tailored program of patient’s education.


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