American Journal of Gastroenterology ISSN 0002-9270 C  2006 by Am. Coll. of Gastroenterology doi: 10.1111/j.1572-0241.2006.00710.x Published by Blackwell Publishing Candidates for Intestinal Transplantation: A Multicenter Survey in Europe CME Loris Pironi, M.D., 1 Xavier H´ ebuterne, M.D., 2 Andre Van Gossum, M.D., 3 Bernard Messing, M.D., 4 Malgorzata Lyszkowska, M.D., 5 Virginie Colomb, M.D., 6 Alastair Forbes, M.D., 7 Ann Micklewright, M.D., 8 Jose Manuel Moreno Villares, M.D., 9 Paul Thul, M.D., 10 Federico Bozzetti, M.D., 11 Olivier Goulet, M.D., 6 and Michael Staun, M.D. 12 1 Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy; 2 Department of Gastroenterology and Clinical Nutrition, University Hospital of Nice, Nice, France; 3 Medico-Surgical Department of Gastroenterology, H` opital Erasme, Free University of Brussels, Brussels, Belgium; 4 Service de Gastroent´ erologie et d’Assistance Nutritive, H` opital Lariboisi´ ere-St. Lazare, Paris, France; 5 Department of Paediatrics, Division of Nutrition, The Children’s Memorial Health Institute, Warsaw, Poland; 6 D` epartement de Gastroent´ erologie, H´ epatologie et Nutrition P´ ediatriques, H ` opital Necker, Enfantes Malades, Paris, France; 7 St. Mark’s Hospital, Harrow, Middlesex, United Kingdom; 8 Dietetic and Nutrition Services, Queens Medical Centre, Nottingham, United Kingdom; 9 U. Nutricion Clinica Y Dietetica, Hospital 12de Octobre, Madrid, Spain; 10 Department of Surgery, Charit´ e University Hospital, Berlin, Germany; 11 Department of Surgery, Hospital of Prato, Prato, Italy; and 12 Department of Gastroenterology, Rigshospitalet, Copenhagen, Denmark. Home Artificial Nutrition Working Group of the European Society for Clinical Nutrition and Metabolism (ESPEN) OBJECTIVES: Epidemiology of candidacy for intestinal transplantation (ITx) and timing for referral for ITx are unknown. Patient candidacy and physician attitudes toward ITx were investigated among centers that participated in previous European surveys on home parenteral nutrition (HPN). METHODS: Patients on HPN for benign intestinal failure (IF) were evaluated by a structured questionnaire. Candidacy was assessed by USA Medicare and American Transplantation Society criteria, categorized as: (1) life-threatening HPN complications; (2) high risk of death because of the gastrointestinal disease; (3) IF with high morbidity or patient HPN refusal. Physicians judged candidacy as immediate or potential. RESULTS: Forty-one centers from nine countries enrolled 688 adults (>18 yr) and 166 pediatric patients; 70% of patients were from five countries which collected 60–100% of their HPN patients. Candidacy was 15.7% in adults and 34.3% in pediatrics (HPN failure, 62.1% and 28.1%; gastrointestinal disease, 25.9% and 59.6%; high morbidity IF or HPN refusal, 12.0% and 12.3%, respectively). Immediate candidacy was required for 14.8% of adult and 15.8% of pediatric candidates (<50% of candidates because of HPN-related liver failure). Among centers, the candidacy rate ranged 0–100% and was negatively associated with the number of patients enrolled in the survey (R =−0.463, p = 0.002). Among the major contributing countries, candidacy ranged 0.3–0.8/million inhabitants for adults and 0.9–2/million inhabitants ≤18 yr for pediatric candidates. CONCLUSIONS: The rate of candidacy and the indications for ITx candidacy differed greatly among age groups and HPN centers; within countries candidacy was more homogeneous; physicians had a generally reserved attitude toward ITx. (Am J Gastroenterol 2006;101:1633–1643) INTRODUCTION Intestinal failure is defined as a reduction in the functioning gut mass below the minimum amount necessary for adequate To access a continuing medical education exam for this article, please visit www.acg.gi.org/journalcme. digestion and absorption of nutrients to achieve and main- tain normal nutritional status (1). Home parenteral nutrition (HPN) is the “artificial gut” for the medical treatment of ir- reversible chronic intestinal failure (CIF). Survival rates on HPN at 1 and 5 yr have been reported to be 91–97% and 62– 68% in adults, and 97% and 89% in children (2–7). Deaths related to HPN complications were 5–20% of the total deaths 1633