Transplant Trial Watch

Pancreas Transplantation for Type 2 Diabetes: A Systematic Review, Critical Gaps in the Literature, and a Path Forward.

Amara, D., et al. (2022).

Transplantation 2022 [record in progress].

The aim of this study was to summarise the available evidence regarding pancreas transplantation in type 2 diabetes (T2D) patients with advanced kidney disease.

A literature search was performed on databases including PubMed, EMBASE, Cochrane CENTRAL and Web of Science. Study selection and data extraction were conducted by two independent reviewers. The Joanna Briggs Institute Critical Appraisal Checklist for Cohort Studies was used to assess the methodological quality of the included studies.

22 full-text studies and 17 published abstracts were included in the review.

The main outcomes of interest were patient survival, graft survival and glycemic control outcomes.


CET Conclusions
This is a well-conducted and well-written report of a systematic review of pancreatic transplantation in type 2 diabetes. Despite the robust methodology of this review in itself, the conclusion of the review suffers from the risk of bias in the only available studies. Multiple databases were searched, and the results were screened in duplicate by 2 authors, before papers were assessed in duplicate as well. The review included 22 papers and 17 abstracts. Critical appraisal of studies was completed in duplicate and, unfortunately, most studies were at high or unclear risk of selection bias, as might be expected from a purely observational group. Most were single-centre studies and there was concern for inconsistencies in definition of type 2 diabetes and graft survival. The inclusion of data from studies published in only abstracts is questionable, however ultimately, they did not contribute to the major part of the review. A key point of interest in the paper is the good summary of current clinical gaps in knowledge, with multiple directions for future research outlined.

Trial registration
PROSPERO - CRD42021227810

Funding source
Non-industry funded