Introduction
Methods
Eligibility criteria
Information sources, search strategy, and records management
First author, year, country | Study design | Data sources | No. cases | Study period | Mean/median age (yr) | Sex (M%) | BMI (kg/cm2) | Duration of DM (yr) | Follow-up | Meta-analysis |
---|---|---|---|---|---|---|---|---|---|---|
Sampaio [15], 2011, USA | Cohort study | UNOS | SPK1: 6141 SPK2: 582 | 2000–2007 | SPK1: 40 (34–46)** SPK2: 47 (40–52) | SPK1: 61** SPK2: 68.7 | SPK1: SPK2** < 18.5: 2.8/2.8 18.5–25: 54.2/43.9 25–30: 32/36.2 > 30: 10.7/17.1 | SPK1: 26 (21–32)** SPK2: 21 (16–27) | Up to 7 y | Meta-B Meta-C |
Margreiter [16], 2013, Austria | Cohort study | Innsbruck Medical University | SPK1: 195 SPK2: 21 KTA2: 32 | 2002/1–2009/9 | SPK1: 41.6 ± 9.2** SPK2: 53.6 ± 5.9 KTA2: 63.5 ± 5.6@@ | SPK1: 66.7** SPK2: 8 KTA2: 90.6@@ | SPK1: 23.4 ± 3.1** SPK2: 25.1 ± 3.3 KTA2: 26.6 ± 2.5@ | SPK1: 24 ± 11.2** SPK2: 15.8 ± 6.3 KTA2: 15.1 ± 7.9@@ | Mean: 7.3 y | Meta-A Meta-B Meta-C |
Jeon [17], 2016, South Korea | Cohort study | Seoul National University Hospital and Samsung Medical Center | SPK1: 20 SPK2: 28 KTA1: 3 KTA2: 69 | 2000/2–2011/12 | SPK1: 34.6 ± 5.8** SPK2: 47.3 ± 9.9 KTA2: 53.6 ± 9 | SPK: 54.2* KTA: 72.2 | SPK: 22.9 ± 4* KTA: 24.1 ± 3.2 | SPK: 18.3 ± 5.5** KTA: 16.4 ± 7.1 | Mean: 53.4 m | Meta-A Meta-B |
Gruessner [11], 2017, USA | Cohort study | UNOS | SPT2: 1322 | 1995–2015 | SPT2: 46.4 ± 8.3 | 70.8 | < 18.5: 24 18.5–24.9: 535 25–29.9: 540 ≥ 30: 44 | SPT2: 21.1 ± 7.9 | Up to 20 y | Meta-A (only for survival rate pancreas graft) |
Fu [18], 2017, China | Cohort study | Tianjin First Central Hospital | SPK1: 36 SPK2: 73 | 2008–2016 | SPK1: 35.4 ± 8.4* SPK2: 50 ± 8 | SPK1: 58.3* SPK2: 82.2 | SPK1: 21.5 ± 3.5* SPK2: 23.9 ± 3.3 | SPK1: 17.6 ± 5.4* SPK2: 20.8 ± 6.7 | NR | Meta-B |
Gondolesi [19], 2018, Argentina | Cohort study | Fundación Favaloro University Hospital | SPK1: 35 SPK2: 10 | 2008/4–2016/3 | SPK1: 36.9 ± 7.8* SPK2: 53.7 ± 7.3 | 54.3 | SPK1: 23.1 ± 3.5** SPK2: 25.72 | SPK1: 24.3 ± 6 .5* SPK2: 20.4 ± 6.5 | Up to 8 y | Meta-A Meta-B |
Alhamad[26], 2019, USA | Cohort study | UNOS | SPK2: 669 KTA2: 25,403 | 2000/1–2016/12 | SPK,P + /SPK,P − /KAT2***: Age group | SPK,P + /SPK,P − /KAT2/LDT2***: 71.7/80/66.5/71 | SPK,P + /SPK,P − /KAT2***: BMI group | NR | Up to 18 y | Meta-A (for survival rate of patient and kidney graft) Meta-C |
Hau[28], 2020, Germany | Cohort study | University Hospital of Leipzig | SPK1: 89 SPK2: 12 KTA2: 26 | 2001–2013 | SPK1/SPK2/KTA2: 42.3 ± 8.4/48.7 ± 10.6/ 61.5 ± 8.6@@ | SPK1/SPK2/KTA2: 55.1/66.7/80.8 | SPK1/SPK2/KTA2: 24.8 ± 4.1/ 26.4 ± 4.9/ 28.6 ± 3.1@ | SPK1/SPK2/KTA2: 27.6 ± 7.9/18.7 ± 9.8/ 18.9 ± 8.9 | 5 y | Meta-A Meta-B |
Fu[27], 2021, China | Cohort study | Tianjin First Central Hospital | KTA2: 85 SPK2: 71 | 2015–2020 | KTA2: 47.6 ± 11.4 SPK2: 48.8 ± 7.8 | KTA2: 80 SPK2: 90 | KTA2: 25.5 ± 4 SPK2: 24.6 ± 3 | KTA2: 12.4 ± 7.2 SPK2: 16 ± 5.7 | Median: 2 y | Meta-A Meta-C |
Study selection
Data collection process
Risk of bias in individual studies
Data synthesis
Results
Search results
Study characteristics
First author, year, country | Study design | Data sources | Definition of diabetes mellitus | Operation description | Definition of renal failure | Definition of pancreas failure | |
---|---|---|---|---|---|---|---|
T2DM | T1DM | ||||||
Sampaio[15], 2011, USA | Cohort study | OPTN/UNOS | Diabetes type definition was taken from the SPK transplant recipient registration form and was based on the diagnosis of ESPD (code 5001 and 5002, corresponding to T1DM and T2DM, respectively) | NR | KRT; RTD; PD; EFU; | PD; pancreas failure | |
Margreiter[16], 2013, Austria | Cohort study | Innsbruck Medical University | Fasting C-peptide was used as the main criterion for defining T2DM, and the absence of autoantibodies (against islet cells, insulin, glutamic acid decarboxylase, or tyrosine phosphatase IA2) | T1DM was defined as an early-onset disease with a sudden need for insulin, presence of one or more autoantibodies, and C-peptide negativity | Y | KRT; RTD; PD | NR |
Jeon[17], 2016, South Korea | Cohort study | Seoul National University Hospital and Samsung Medical Center | Patients who did not meet the diagnostic criteria of type 1 DM were categorized to type 2 DM. Those who had a low cardiovascular risk and a body mass index (BMI) of < 30 kg/m2 among type 2 DMESKD patients were considered acceptable for SPK | Age at disease onset < 40 yr, and the maximum weight ≤ 105% of the standard body weight with at least one of the following: (i) history of diabetic ketoacidosis, (ii) starting insulin therapy within one yr after diagnosis. The laboratory results of low fasting C-peptide (< 0.8 ng/mL) and presence of anti-pancreatic or anti-insulin autoantibodies supported the classification of type 1 diabetes | NR | KRT; RTD; PD | PD; insulin resumption; taking oral hypoglycemic agents due to hyperglycemia |
Fu[18], 2017, China | Cohort study | Tianjin First Central Hospital | NR | NR | Y | KRT; RTD; PD | NR |
Gruessner[11], 2017, US | Cohort study | OPTN/UNOS | The guidelines of the American Diabetes Association (ADA) | NR | KRT; RTD; PD | PD; insulin resumption | |
Gondolesi[19], 2018, Argentina | Cohort study | Fundación Favaloro University Hospital | T2DM: were patients usually diagnosed over 30 years of age, they often present with associated increased body weight; high blood pressure; and/or cholesterol levels. Initial management has usually been diet. Although C-peptide is not considered diagnostic of T2DM, it usually divides patients as resistant to insulin (when its value is greater than 2.35 ng/mL) or as the absence of insulin production, when the value is normal or below normal. Determinations of antibodies should have been negative in this group of patients | T1DM: Often diagnosed in childhood, not associated with excess body weight, often associated with higher-than-normal ketone levels at diagnosis, treatment should have been done with insulin. And, patients should have test positive for autoantibodies (GAD, IA2, or ZnTA8), although there have been described cases with negative autoimmunity | Y | Serum creatinine levels and creatinine clearance | Measuring C-peptide, serum glycemia, insulin levels |
Alhamad[26], 2019, USA | Cohort study | OPTN/UNOS | Diabetes type definition was taken from the SPK transplant recipient registration form and was based on the diagnosis of ESPD (code 5001 and 5002, corresponding to T1DM and T2DM, respectively) | NR | KTR; RTD; PD | UNOS definition based on program-specific reports | |
Hau[28], 2020, Germany | Cohort study | University Hospital of Leipzig | The guidelines of the American Diabetes Association (ADA) and the World Health Organization (WHO). Selection criteria for pancreas transplantation in T2DM in our center include patients < 60 years with a body mass index of < 30 kg/m2, fasting C-peptide levels < 10 ng/mL, insulin requirement for a minimum of 5 years with daily requirements of less than 1 U/kg per day, absence of pancreatic antibodies (anti-glutamic acid decarboxylase (GAD)), islet cell antibodies (ICA), anti-tyrosine phosphatase (anti-IA2), absence of severe vascular disease and adequate cardiac function | Y | KRT; RTD; PD; EFU | PD; pancreas failure with resumed insulin therapy; EFU | |
Fu[27], 2021, China | Cohort study | Tianjin First Central Hospital | 1999 WHO guidelines and 2013 Guidelines for the prevention and control of type 2 diabetes in China | Y | KRT; RTD; PD | PD; PT; resumption of the daily scheduled insulin |
Definition of T2DM and definition of renal failure and pancreas failure
Methodological quality of included studies
Author, year | Selection | Comparability | Outcome | Total stars | |||||
---|---|---|---|---|---|---|---|---|---|
S1 | S2 | S3 | S4 | C1 | O1 | O2 | O3 | ||
Sampaio[15], 2011 | ** | * | * | * | * | — | — | 6/11 | |
Margreiter[16], 2013 | * | * | — | * | ** | — | 5/11 | ||
Jeon[17], 2016 | ** | * | * | * | — | * | * | — | 7/11 |
Fu[18], 2017 | * | * | * | * | — | — | — | — | 4/11 |
Gruessner[11], 2017 | ** | NA | * | * | NA | * | * | — | 6/9 |
Gondolesi[19], 2018 | * | * | * | — | * | — | — | 4/11 | |
Alhamad[26], 2019 | ** | * | * | * | * | * | * | — | 8/11 |
Hau[28], 2020 | * | * | * | — | * | ** | — | 6/11 | |
Fu[27], 2021 | * | * | * | * | * | * | — | * | 7/11 |
Survival rates
Pooled 1-year, 3-year, and 5-year survival rates of patients, kidney graft, and pancreas graft (Fig. 2A–C)
Meta-analysis of patient and graft HR among T2DM compared with T1DM (Fig. 3A–C)
Meta-analysis of patient and graft HR among T2DM after SPK compared with KTA (Fig. 4A–B)
Meta-analysis of complications RR among T2DM compared with T1DM (SDC-Figure S2)
First author and year | Rejection | DGF | Infection | Thrombosis | ||||
---|---|---|---|---|---|---|---|---|
Definition | Rate (%) | Definition | Rate (%) | Definition | Rate (%) | Definition | Rate (%) | |
Sampaio[15], 2011 | NR | SPK1: 15.8 SPK2: 14.7 | NR | SPK1/SPK2: Kidney: 7.8/11.7 | NR | SPK1/SPK2: 4.37/2.95 | NR | NR |
Margreiter[16], 2013 | Clinical & biopsy | SPK1: 9.3 SPK2: 10 KTA2: 9.4 | NR | SPK1/SPK2/KTA2: Pancreas: 16.4/15 Kidney: 12.3/15 | NR | SPK1/SPK2/KTA2: 16.3/19/28.9 | NR | NR |
Jeon[17], 2016 | NR | SPK1: 45 SPK2: 35.7 | NR | NR | NR | NR | NR | NR |
Fu[18], 2017 | NR | SPK1: 13.9 SPK2: 5.5 | NR | SPK1/SPK2: Pancreas: 0/13.7 Kidney: 2.8/5.5 | NR | SPK1: 30.6 SPK2: 41.1 | NR | NR |
Gondolesi[19], 2018 | Clinical diagnose | Kidney: 17.5 | NR | Kidney: 21.7 | NR | NR | NR | NR |
Alhamad[26], 2019 | NR | NR | NR | NR | NR | NR | NR | NR |
Hau[28], 2020 | ** | SPK1/SPK2/KTA2: 21.3/58.3/15.44 | Y | SPK1/SPK2/KTA2: Pancreas: 4.5/8.3/- Kidney: 14.9/16.7/42.3 | NR | SPK1/SPK2: 6.7/8.3 | NR | SPK1/SPK2: 10/9.1 |
Fu[27], 2021 | Biopsy | SPK2/KTA2: 10.5/10.5 | Y | SPK2/KTA2: 2.6/2.6 | NR | SPK2/KTA2: 44.7/15.2 | NR | NR |