An Evidence-Based Analysis of Simultaneous Pancreas-Kidney and Pancreas Transplantation Alone

While pancreas transplantation has evolved within two decades from a frustrating and poorly-accepted therapeutic option to a highly successful procedure, the respective benefits of the successive surgical and immunosuppressive developments have remained un-clear. The aim of this study was to determine us-ing an evidence-based methodology, which novel ap-proaches have contributed to the current results and whether pancreas transplantation is cost-effective. Out of 2481 articles, 102 analyzed either surgical or immunosuppressive aspects of pancreas transplanta-tion. Urological complications were more frequent in bladder over enteric drainage (range: 62–63 % vs. 12– 20%, p = 0.0001), but without significant difference in patient or graft survival. Portal drainage was associ-ated with a trend toward fewer complications and bet-ter hyperinsulinemia control over systemic drainage in retrospective studies. Immunosuppression combin-ing induction therapy, a calcineurin inhibitor, mycophe-nolate mophetil (MMF) and corticosteroids were as-sociated with a 40 % decreased incidence of rejection (p = 0.01) and an increase in graft survival above 90 % at 1 year (p < 0.05). Pancreas transplantation is highly cost-effective compared to conservative alter-natives. We conclude that despite a paucity of large studies, enteric drainage should be recommended but the benefits of portal venous drainage remain de-bated. Quadruple immunosuppression protocols in-cluding induction therapy should be the standard regimen. Key words: Drainage techniques, evidence-based medicine, immunosuppression, pancreas transplanta-tion alone, simultaneous pancreas kidney transplan-tatio