An Evidence-based Analysis of Simultaneous Pancreas Kidney Transplantation: Portal versus Systemic Venous Drainage of Pancreas Allograft_Chinese Journal of Evidence-Based Medicine

Authors：

LI Yongsheng ¹ , LI Lulu ¹ , HUANG Yuchuan ¹ , TANG Yong ² , PANG Lili ¹ , ZHAO Na ¹ , FENG Li ¹ , LI Shengfu ¹ , LONG Dan ¹ ,  LI Youping ¹³

1. Lab of Transplant Engineering and Immunology, West China Hospital, Sichuan University; Chengdu 6100441, China;2. Department of Pancreas Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China;3. Chinese Evidence-Based Medicine/ Cochrane Centre, West China Hospital, Sichuan University, Chengdu 6100441, China;

Corresponding author：

LI Youping, Email: yzmylab@hotmail.com

Keywords：

Simultaneous pancreas-kidney transplantation; Portal venous drainage; Systemic venous drainage; Complication; Graft survival rate

DOI：

10.7507/1672-2531.20080078

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Objective 　To evaluate the impact of portal or systemic venous pancreas graft drainage on patient and graft outcomes following simultaneous pancreas kidney transplantation (SPK).
Methods 　We searched The Cochrane Library (2008, Issue 1), PubMed (1970 to Feb 2008) and EMBASE (1974 to Feb 2008) to find studies concerning the effect of systemic versus portal venous pancreas graft drainage on patient and graft outcomes. Meta-analyses were conducted using The Cochrane Collaboration’s RevMan 4.2 software.
Results 　Three RCTs involving 401 simultaneous pancreas kidney transplants were included in our meta-analysis. Statistically significant differences were only observed in 3- and 5-year pancreas graft survival rates (P=0.03 and P=0.05). No significant difference was noted in patient or kidney graft survival rates.
Conclusion 　Currently available evidences from RCTs does not support the effectiveness of portal drainage in preventing thrombosis, rejection or infection after SPK. Large-scale, long-term and appropriately designed RCTs are required to conclude whether portal and systemic drainage in pancreas transplantation are equivalent in terms of patient and graft survival.

Citation： LI Yongsheng,LI Lulu,HUANG Yuchuan,TANG Yong,PANG Lili,ZHAO Na,FENG Li,LI Shengfu,LONG Dan,LI Youping. An Evidence-based Analysis of Simultaneous Pancreas Kidney Transplantation: Portal versus Systemic Venous Drainage of Pancreas Allograft. Chinese Journal of Evidence-Based Medicine, 2008, 08(5): 358-363. doi: 10.7507/1672-2531.20080078 Copy

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1. Robertson RP. 2005 update: impact of pancreas and islet transplants on acute and chronic complications of diabetes. Current Opinion in Organ Transplantation, 2005, 10(2): 176-180.
2. Petruzzo P, Lefrancois N, Berthillot C, et al. Impact of pancreatic venous drainage site on long-term patient and graft outcome in simultaneous pancreas-kidney transplantation. Clin Transplant, 2008, 22(1): 107-112.
3. Stratta RJ, Alloway RR, Lo A, et al. Does surgical technique influence outcomes after simultaneous kidney-pancreas transplantation? Transplant Proc, 2004, 36(4): 1076-1077.
4. Stratta RJ, Shokouh-Amiri MH, Egidi MF, et al. A prospective comparison of simultaneous kidney pancreas transplantation with systemic-enteric versus portal-enteric drainage. Ann Surg, 2001, 233(6): 740-751.
5. Yasumura T, Kahan BD. Prolongation of rat kidney allografts by pretransplant administration of donor antigen extract or whole blood transfusion combined with a short course of cyclosporine. Transplantation, 1983, 36(6): 603-609.
6. Humar A, Khwaja K, Ramcharan T, et al. Chronic rejection: the next major challenge for pancreas transplant recipients. Transplantation, 2003, 76(6): 918-923.
7. Benz S, Busing M, Kruger B, et al. Pancreas graft thrombosis: is there a role for trypsin. Pancreas, 2004, 28(1): 75-79.
8. Diem P, Abid M, Redmon JB, et al. Systemic venous drainage of pancreas allografts as independent cause of hyperinsulinemia in type I diabetic recipients. Diabetes, 1990, 39(5): 534-540.
9. Gruessner AC, Sutherland DER. Pancreas transplant outcomes for United States(US) and non-US cases as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR) as of June 2004. Clin Transplant, 2005, 19(4): 433-455.

Chinese Journal of Evidence-Based Medicine

An Evidence-based Analysis of Simultaneous Pancreas Kidney Transplantation: Portal versus Systemic Venous Drainage of Pancreas Allograft

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