Simultaneous pancreas and kidney transplantation for end-stage kidney disease patients with type 2 diabetes mellitus: a systematic review and meta-analysis.Cao, Y., et al.
Langenbecks Archives of Surgery 2021 [record in progress].
The aim of this study was to investigate the survival outcomes of simultaneous pancreas and kidney transplantation (SPK) among end‑stage kidney disease patients (ESKD) with type 2 diabetes mellitus (T2DM).
A literature search was conducted on MEDLINE, PubMed, EMBASE, Cochrane CENTRAL, Chinese Biomedical Literature Database, China National Knowledge Infrastructure (CNKI), and the Wan-Fang database. Study selection and data extraction were performed by two independent reviewers. The risk of bias was assessed using the Newcastle–Ottawa Scale (NOS).
16 studies were included in the review.
Primary outcomes were graft survival and patient survival. Secondary outcomes included hazard ratio of patient survival, graft survival and post-transplant complications for type 1 diabetes mellitus (T1DM) versus T2DM, and for SPK versus kidney transplant alone (KTA) among T2DM patients.
This is a well written and well conducted systematic review. Multiple databases were searched and references were filtered in duplicate by 2 authors. Data extraction was also completed in duplicate. All included studies were retrospective cohort studies, and were appropriately and formally assessed using the Newcastle Ottawa Scale. Meta-analysis was done to estimate combined outcomes for survival outcomes and complication rates. Sensitivity analysis was done to search for sources of heterogeneity and in one case identified a single study with short follow up that explained this. Despite the Type 2 diabetes patients tending to be older and larger BMI, the patient and graft outcomes following SPK transplant were similar compared to patients with Type1 diabetes. A key limitation of this review is the lack of defined complications in pancreas transplantation that hampers data synthesis across studies. The key analysis of interest in this paper is SPK in Type 2 diabetes compared to kidney transplant alone. Unfortunately, this is a highly selected population and the possibility for bias is very high. In this analysis, SPK in Type 2 diabetes was associated with improved kidney graft and patient survival compared to kidney transplant alone. This should be viewed with caution as it is based upon 4 cohort studies and these need to be analysed independently to find out what population specifics there are for the patients with Type 2 diabetes undergoing SPK.
PROSPERO - CRD42019118321