LAUSR

Introduction: The use of home parenteral nutrition (HPN) for patients with intestinal failure (IF) varies widely among countries. Robust Australian data regarding epidemiology of IF patients on HPN are limited as there is currently no HPN registry to capture demographic, quality indicators or outcome data. The aim of this study was to provide a description of the HPN patient population at our institute over the time period during which the intestinal transplant (ITx) program for Australia was implemented at our centre. Methods: Retrospective electronic medical record review of all patients with IF discharged from our hospital on HPN from 1st January 2007 to 31st December 2016. Data were reported as per ESPEN endorsed classification, with additional PN-related complication and patient outcomes documented. Results: Forty-six patients (61% female) with average age 48.9 years (range 19–76) were discharged on HPN over the 10-year period, with ITx introduced in 2009. Leading causes of IF were short bowel syndrome (67%) followed by dysmotility (13%), fistulae (9%), mechanical obstruction (7%) and mucosal disease (4%); predominantly caused by complications from non-IBD, noncancer abdominal surgery (33%); mesenteric vascular events (22%), IBD (17%) and cancer (11%). Median duration of TPN was 350 days (range 44–9125 days). Thirty-two patients (70%) experienced at least 1 severe complication related to their TPN; primarily line sepsis (n=32), followed by IFALD (n=17) and thrombosis (n=11). Complications were more prevalent as length of HPN therapy increased. The incidence of septic complications related to central lines was high at 2.56 infections/1000 HPN days. While receiving HPN, 17 patientswith IF (37%) died. Three deathswereHPN related (2 sepsis, 1 central venous thrombosis), the remainder due to underlying disease. Fourteen patients (30%) underwent nutritional, medical and surgical intestinal rehabilitation and were weaned from TPN; 3 (7%) had intestinal transplant (100% survival and all weaned from PN); 5 (11%) have been able to reduce days reliant on PN, and; 7 (15%) remain on HPN 7 days per week. The number of patients per year discharged on HPN has more than doubled during the observed time period, and patients’ remaining active on HPN has increased 4-fold. Conclusion: These tertiary centre–based data confirm that point prevalence of IF has increased in the short term, since the introduction of the Australian ITx program at our centre. Catheter related blood stream infection rates remain high when bench-marked against international outcome data suggesting improvement in line-care protocols need to be implemented. Intestinal rehabilitation and transplantation to reduce PN dependence has proven successful in the majority of cases. Nationwide collaboration to capture quality indicators and resource utilisation data is now required to facilitate improvements in the quality of care for patients on HPN in Australia. 2b.160