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Sammanfattning

Denmark was among the first countries to introduce home parenteral nutrition as a treatment for intestinal failure. Today, every patient with short bowel syndrome should receive this lifesaving treatment whatever the length of the remaining bowel. In the United States, small-bowel transplantation has become an approved treatment of intestinal failure in the small fraction of patients expected to have a high mortality rate caused by complications to parenteral nutrition (liver failure, repetitive thromboses and sepsis). The number of transplantations has stabilized at about 90 a year, and the world rate is probably approaching 900. However, the five-year mortality rate is still high, about 50%. The Danish experience in adults shows that centralised treatment reduces the five-year mortality rate with home parenteral nutrition per se to 4%, including liver failure (2%), sepsis (2%) and venous inac-cessibility (0%). A quarter of all patients will adapt to a life without parenteral nutrition and another quarter will die within five years due to non-transplantation-related causes. The remaining patients are those who would benefit from receiving a functioning small-bowel graft, as well as those with a good long-term prognosis, and until the survival rate improves, the dilemma of whether or not to transplant a bowel will remain.

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