Objective To collect and analyze published experimental and clinical studies about the protective function of ischemic preconditioning (IPC) to organs, in order to learn the history of IPC, the progress of experimental as well as clinical studies, and explore the mechanism of IPC in organ transplantation. Methods The electronic search of MEDLINE (1966 to Aug. 2009), EMbase (1974 to Aug. 2009) and The Cochrane Library (Issue 2, 2009) were performed to include and exclude the retrieved articles by two reviewers independently. The included studies were further treated for analysis and discriptive review. Results A total of 1 398 papers were included, of which about 75 percent were experimental studies, and only about 25 percent were clinical studies. About 73 percent studies focused on the heart and liver. Althrough the studies about the effects induced by IPC on the heart, brain, spinal cord and liver increased obviously in recent years, the clinical studies concerned the heart and liver operation and transplantation still far lagged behind experimental studies, especially very few clinical studies on the effect induced by IPC on kidney, lung, gastrointestinal tract and pancreas. Conclusion IPC intervention can effectively protect the heart and lung from the I/RI during the surgical and transplatational operations, and the hepat-surgical and living liver transplantational operations. IPC can effectively protect the brain and spinal cord from I/RI, but no protective function to cadaveric liver transplantation. However, the IPC effects on the kidney and gastrointestinal tract are not confirmed and neither is the mechanism of the effect induced by IPC.
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.