An evidence-based analysis of simultaneous pancreas-kidney and pancreas transplantation alone

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
Nicolas DemartinesPierre-Alain Clavien

Abstract

While pancreas transplantation has evolved within two decades from a frustrating and poorly-accepted therapeutic option to a highly successful procedure, the respective benefits of the successive surgical and immunosuppressive developments have remained unclear. The aim of this study was to determine using an evidence-based methodology, which novel approaches have contributed to the current results and whether pancreas transplantation is cost-effective. Out of 2481 articles, 102 analyzed either surgical or immunosuppressive aspects of pancreas transplantation. Urological complications were more frequent in bladder over enteric drainage (range: 62-63% vs. 12-20%, p = 0.0001), but without significant difference in patient or graft survival. Portal drainage was associated with a trend toward fewer complications and better hyperinsulinemia control over systemic drainage in retrospective studies. Immunosuppression combining induction therapy, a calcineurin inhibitor, mycophenolate mophetil (MMF) and corticosteroids were associated with a 40% decreased incidence of rejection (p = 0.01) and an increase in graft survival above 90% at 1 year (p < 0.05). Pancreas transplantation is highly cost-effective compared to conservative alternati...Continue Reading

References

Apr 1, 1984·World Journal of Surgery·D E Sutherland
Jun 1, 1995·Annals of Surgery·A Osama GaberL G Britt
Sep 30, 1993·The New England Journal of Medicine·Diabetes Control and Complications Trial Research GroupC Siebert
Jul 9, 1998·The New England Journal of Medicine·P FiorettoM Mauer
Sep 22, 1998·Annals of Surgery·H W SollingerJ D Pirsch
Apr 17, 2001·Annals of Surgery·D E SutherlandJ S Najarian
Jan 24, 2002·European Surgical Research. Europäische Chirurgische Forschung. Recherches Chirurgicales Européennes·H J KisslerP O Schwille
Apr 27, 2002·American Journal of Surgery·Jonathan L Meakins
Dec 6, 2003·JAMA : the Journal of the American Medical Association·Jeffrey M VenstromDavid M Harlan
Dec 4, 2004·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Rainer W G GruessnerA C Gruessner

Citations

Jun 11, 2009·Journal of Huazhong University of Science and Technology. Medical Sciences = Hua Zhong Ke Ji Da Xue Xue Bao. Yi Xue Ying De Wen Ban = Huazhong Keji Daxue Xuebao. Yixue Yingdewen Ban·Changsheng MingXiaoping Chen
Jul 26, 2012·Current Diabetes Reports·Ugo BoggiGabriella Amorese
Feb 3, 2009·Journal of the Chinese Medical Association : JCMA·Yi-Ming Shyr
Jul 18, 2012·Seminars in Pediatric Surgery·Paul R V Johnson, Katherine E Jones
Jul 14, 2010·Transplantation Proceedings·A Arjona-SánchezS Rufián-Peña
Sep 1, 2009·Transplantation Proceedings·J Medina PoloF de la Rosa
Dec 23, 2008·Transplantation Proceedings·P MatiasIrene Lourdes Noronha
Jul 15, 2009·Transplant Infectious Disease : an Official Journal of the Transplantation Society·A S R MuthusamyP J Friend
Oct 16, 2008·Transplant International : Official Journal of the European Society for Organ Transplantation·Davide MineoCamillo Ricordi
Nov 17, 2007·Transplant International : Official Journal of the European Society for Organ Transplantation·Richard HummelJens G Brockmann
Aug 21, 2008·Transplant International : Official Journal of the European Society for Organ Transplantation·D Cantarovich, Fabio Vistoli
Jun 1, 2006·Journal of the American College of Surgeons·Julian E LosanoffJ Michael Millis
Jun 3, 2015·Clinical Transplantation·Fernando García BarradoGiovanni A Matricali
Mar 14, 2013·Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases·J M Herrero-MartínezJ M Aguado
Feb 1, 2007·Current Opinion in Organ Transplantation·David Axelrod, Dixon B Kaufman
Dec 10, 2013·Current Opinion in Organ Transplantation·Ty B Dunn
Apr 29, 2008·Arquivos brasileiros de endocrinologia e metabologia·João Roberto de SáFreddy Goldberg Eliaschewitz

Related Concepts

Therapeutic Immunosuppression
Pancreas Transplantation
Islets of Langerhans Transplantation
Evidence-Based Medicine

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