Meta-Analysis
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Jan 18, 2023; 13(1): 10-24
Published online Jan 18, 2023. doi: 10.5500/wjt.v13.i1.10
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
Shrouq Khazaaleh, Department of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, OH 44126, United States
Sumbal Babar, Department of Internal Medicine-Infectious Diseases Division, University of Texas Health Science Center at San Antonio, San Antonio, TX 78249, United States
Mohammad Alomari, Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, FI 33324, United States
Zaid Imam, Department of Gastroenterology and Hepatology, William Beaumont Hospital, Royal Oak, MI 48073, United States
Pravallika Chadalavada, Adalberto Jose Gonzalez, Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, FI 33331, United States
Bara El Kurdi, Department of Gastroenterology and Hepatology, University of Texas Health Science Center at San Antonio, San Antonio, TX 78249, United States
Author contributions: Khazaaleh S and Babar S contributed to study design, data interpretation, manuscript writing, and administrative support; Alomari M contributed to literature review and data collection; Imam Z and Chadalavada AJ contributed to data assembly, and data analysis including statistical analysis and creating tables and graphs; Kurdi BE contributed to supervisory role, data interpretation and primary investigator; all authors contributed to the paper writing, and manuscript revision and approved the submitted version of this manuscript.
Conflict-of-interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bara El Kurdi, MD, Academic Fellow, Department of Gastroenterology and Hepatology, University of Texas Health science center at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, United States. baraabayern@gmail.com
Received: October 7, 2022
Peer-review started: October 7, 2022
First decision: November 14, 2022
Revised: November 24, 2022
Accepted: December 23, 2022
Article in press: December 23, 2022
Published online: January 18, 2023
Processing time: 97 Days and 7.1 Hours
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.

Keywords: Islet autotransplantation; Pancreatectomy; Pancreatitis; Narcotics

Core Tip: Surgical intervention is required for the management of debilitating and refractory abdominal pain in chronic pancreatitis (CP) patients failing medical therapy. Since first introduced in 1978, total pancreatectomy with islet autotransplantation (TPIAT) has shown promising results in CP patients, but the literature remains limited. This systematic review and meta-analysis found that TPIAT provided acceptable levels of pain relief and insulin independence.