Outcomes of total pancreatectomy with islet autotransplantation: A systematic review and meta-analysis.

Shrouq Khazaaleh, Sumbal Babar, Mohammad Alomari, Zaid Imam, Pravallika Chadalavada, Adalberto Jose Gonzalez, Bara El Kurdi
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Abstract

Background: Despite the increased use of total pancreatectomy with islet autotransplantation (TPIAT), systematic evidence of its outcomes remains limited.

Aim: To evaluate the outcomes of TPIAT.

Methods: We searched PubMed, EMBASE, and Cochrane databases from inception through March 2019 for studies on TPIAT outcomes. Data were extracted and analyzed using comprehensive meta-analysis software. The random-effects model was used for all variables. Heterogeneity was assessed using the I2 measure and Cochrane Q-statistic. Publication bias was assessed using Egger's test.

Results: Twenty-one studies published between 1980 and 2017 examining 1011 patients were included. Eighteen studies were of adults, while three studied pediatric populations. Narcotic independence was achieved in 53.5% [95% Confidence Interval (CI): 45-62, P < 0.05, I2 = 81%] of adults compared to 51.9% (95%CI: 17-85, P < 0.05, I2 = 84%) of children. Insulin-independence post-procedure was achieved in 31.8% (95%CI: 26-38, P < 0.05, I2 = 64%) of adults with considerable heterogeneity compared to 47.7% (95%CI: 20-77, P < 0.05, I2 = 82%) in children. Glycated hemoglobin (HbA1C) 12 mo post-surgery was reported in four studies with a pooled value of 6.76% (P = 0.27). Neither stratification by age of the studied population nor meta-regression analysis considering both the study publication date and the islet-cell-equivalent/kg weight explained the marked heterogeneity between studies.

Conclusion: These results indicate acceptable success for TPIAT. Future studies should evaluate the discussed measures before and after surgery for comparison.

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全胰切除术合并胰岛自体移植的结果:系统回顾和荟萃分析。
背景:尽管全胰切除术联合胰岛自体移植(TPIAT)的应用越来越多,但其结果的系统证据仍然有限。目的:评价TPIAT的治疗效果。方法:我们检索了PubMed、EMBASE和Cochrane数据库,从成立到2019年3月,检索了关于TPIAT结果的研究。采用综合元分析软件对数据进行提取和分析。所有变量均采用随机效应模型。采用I2测量和Cochrane q统计量评估异质性。采用Egger’s检验评估发表偏倚。结果:1980年至2017年间发表的21项研究纳入了1011名患者。18项研究针对成年人,3项研究针对儿科人群。成人53.5%[95%可信区间(CI): 45-62, P < 0.05, I2 = 81%]达到麻醉药品独立,儿童51.9% (95%CI: 17-85, P < 0.05, I2 = 84%)达到麻醉药品独立。31.8% (95%CI: 26-38, P < 0.05, I2 = 64%)的成人术后实现胰岛素独立,具有相当大的异质性,而儿童术后实现胰岛素独立的比例为47.7% (95%CI: 20-77, P < 0.05, I2 = 82%)。4项研究报告了术后12个月糖化血红蛋白(HbA1C),合并值为6.76% (P = 0.27)。研究人群的年龄分层和考虑研究发表日期和胰岛细胞当量/kg体重的meta回归分析都不能解释研究之间的显著异质性。结论:这些结果表明TPIAT治疗成功。未来的研究应评估术前和术后的措施,以进行比较。
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