• Home parenteral nutrition
• intestinal transplantation
• candidacy
• outcome
• parenteral nutrition

Pironi et al recently published an article challenging current indications for intestinal transplantation (IT).1 The European home parenteral nutrition (HPN) database of 41 centres in nine countries was utilised and a 5-year prospective cross-sectional survey was conducted focusing on transplant candidacy with survival and causes of death as end points. With appreciation of the authors' scientific contribution, we felt obligated to highlight major flaws in the study design.

Identification of HPN patients who are candidates for transplant was the Achilles' heel of the study. Unfortunately, such determination, without formal listing, was based upon broad definitions and questionnaire data short of documented objective testing that is crucial to transplant candidacy.2 Another major concern is the small number of candidates who were actually transplanted (14.5%). In addition, limited centre experience in transplant versus HPN questioned the accuracy of data interpretation. Equally important is …