Simultaneous pancreas and kidney transplantation for end-stage kidney disease patients with type 2 diabetes mellitus: a systematic review and meta-analysis
The indications for patients with type 2 diabetes mellitus (T2DM) combined with end-stage kidney disease (ESKD) undertaking simultaneous pancreas and kidney transplantation (SPK) remain an unresolved issue. This study aimed to systematically review the survival outcomes of SPK among T2DM-ESKD patients.
METHODS:Online databases including PubMed, MEDLINE, EMBASE, and the CENTRAL Library, CNKI, Chinese Biomedical Literature Database, and Wan-Fang database were used to locate the studies of ESKD patients with T2DM undertaking SPK up to May 2021. A third reviewer was consulted if there were disagreements. Data were analyzed with STATA (15.0).
RESULTS:Nine cohort studies were identified. The pooled 1-year, 3-year, and 5-year patient survival rates of patients with T2DM and ESKD after SPK were 98%, 95%, and 91% respectively. Comparing the treatment effect of SPK between type 1 diabetes mellitus (T1DM) and T2DM, the survival estimates were comparable. For T2DM patients, SPK had a survival advantage compared with KTA.
CONCLUSIONS:The synthesized clinical outcomes of T2DM patients with ESKD after SPK were relatively better than KTA, but a subset of T2DM-ESKD patients who would benefit the most from SPK was to be defined. PROSPERO registration number CRD42019118321. Date of registration: 14 Jan 2019 (retrospectively registered).
CET Conclusion
| Reviewer: | Mr John O'Callaghan, Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences University of Oxford |
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| Conclusion: | 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. |
Study Details
| Aims: | 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). |
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| Interventions: | 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). |
| Participants: | 16 studies were included in the review. |
| Outcomes: | 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. |
| Follow Up: | N/A |
Metadata
| Funding: | Non-industry funding |
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| Publication type: | Meta-Analysis, Systematic Review |
| Review registration: | PROSPERO - CRD42019118321 |
| Organ: | Various; Kidney; Pancreas; Simultaneous Kidney/Pancreas |
| Language: | English |
| Author email: | yingxinfu@nankai.edu.cn |
| MeSH terms: | Diabetes Mellitus, Type 2; Graft Survival; Humans; Kidney Failure, Chronic; Kidney Transplantation; Pancreas; Pancreas Transplantation |