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Intestinal transplantation and the European implication: impact of experience and study design
  1. Kareem M Abu-Elmagd,
  2. George Mazariegos
  1. University of Pittsburgh Medical Center, Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Kareem M Abu-Elmagd, University of Pittsburgh Medical Center, Thomas E. Starzl Transplantation Institute, 3459 Fifth Avenue, MUH 7 South, Pittsburgh, PA 15213, USA; abuelmagdkm{at}

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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 …

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  • Competing interests None.

  • Provenance and peer review Not commissioned; not externally peer reviewed.

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  • PostScript
    Loris Pironi Alastair Forbes André Van Gossum Home Artificial Nutrition & Chronic Intestinal Failure Working Group of the European Society for Clinical Nutrition and Metabolism (ESPEN)