2017 - CIRTA

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6- Medical and Surgical Rehabilitation

20.7 - Multiple central venous catheter-related vein thrombosis (CVC-VT) is not an indication for a straight listing for a life-saving intestinal transplantation (ITx) in adults

Presenter: Loris, Pironi, Bologna, Italy
Authors: Alice Bondi, Mariacristina Guidetti, Federica Agostini, Caterina Pazzeschi, Anna Sasdelli, Loris Pironi

Multiple central venous catheter-related vein thrombosis (CVC-VT) is not an indication for a straight listing for a life-saving intestinal transplantation (ITx) in adults

Alice Bondi1, Mariacristina Guidetti1, Federica Agostini1, Caterina Pazzeschi1, Anna S. Sasdelli1, Loris Pironi1.

1Medical and Surgical Science, St. Orsola Hospital, University of Bologna, Bologna, Italy

Center for Chronic Intestinal Failure.

Introduction: The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines for CIF in adults suggest that patients on home parenteral nutrition (HPN) with CVC-VT occluding ≥ 2 central veins be listed for a life-saving ITx on a case-by-case basis [1]. An individual CIF center retrospective survey was carried out to investigate the survival rate on HPN (SR) and the causes of death, in adult patients with CIF due to benign disease who developed a CVC-VT.

Methods: The prospectively collected data of all the CIF patients treated with HPN between 1986 and 2015 were retrospectively reviewed on April 30th 2015. Patient, CIF and HPN characteristics as well as the episodes of CVC-VT (in internal jugular, subclavian, femoral and superior vena cava veins) were recorded. Exclusion criteria: age < 18 years and presence of cancer at time of study. Statistic: Kaplan–Meier method and non parametric tests.

Results: A cohort of 271 patients was analyzed for a total 1429 CVC-years. Fifty-two patients had 83 episodes of CVC-VT (incidence: 0.058 per CVC-year). In the total cohort, the SR was 98%, 88%, 71% and 58% at 1, 5, 10 and 20 years, respectively; the SR was negatively associated with the decade of age at starting HPN (<18, 18-50, >50 year; p=0.001).

In the 244 patients who started HPN at age ≥18 years, the SR did not differ between the 45 who had (VT) and the 198 who didn’t have (no-VT) a CVC-VT (p=0.982). The VT group had a longer duration of HPN and a greater number of inserted CVC and of episodes of CVC-related infections (all p<0.001). The HPN-related causes of death were 32% and 38% of total deaths in the VT and the no-VT groups, respectively (p=0.635). Two deaths were due to CVC-VT (5.7% of death in the adult patient groups). In the VT, the SR after the first episode of CVC-VT did not differ on the basis of the number of occluded veins (≤2, n.28; >2, n.17; P=0.277).

Conclusion: In adult patients on HPN for CIF due to benign disease, the development of a CVC-VT is not associated with either an increased risk of death or an increased risk of HPN-related death. These results confirm the ESPEN guidelines for CIF in adults: patients with multiple CVC-VT should be listed for a life-saving ITx only on a case-by-case basis.

[1] Pironi L. et al. Clin Nutr. 2016; 35: 247-207

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