Pancreatic transplantation: Brief review of the current evidence

Table 3 Sample of studies evaluating the effect of pancreatic transplantation on the complications of diabetes mellitus

Ref.	Patient cohorts	Outcomes of interest	Time after transplant (yr)	Results
Cardiovascular disease
Fiorina et al[9], 2000	SPK (n = 42) vs KTA (n = 26) vs type 1 diabetes (n = 20)	Left ventricular systolic and diastolic function assessed by radionuclideventriculography	4 yr	Left ventricular ejection fraction was higher in SPK recipients than in KTA recipients [75.7 (SD 1.8%) vs 65.3% (2.8%); P = 0.02] and type 1 diabetes controls (75.7 (1.8%) vs 61.2 (3.7%); P = 0.004).
Biesenbach et al[10], 2005	SPK (n = 12) vs KTA (n = 10)	Composite endpoint of myocardial infarction, stroke, and amputation	10 yr	Lower incidence of myocardial infarction (16% vs 50%), stroke (16% vs 40%), and amputations (16% vs 30%) in SPK vs KTA recipients (P < 0.05 for composite endpoint of all three events)
Diabetic nephropathy
Fioretto et al[11], 1998	PTA: Pre-transplant vspost-transplant (n = 8)	Native kidney biopsy:structural morphology	10 yr	Improvement in glomerular basement membrane thickening, tubular basement membrane thickening, and mesangial expansion after transplantation compared with before
		before and after transplant
Boggi et al[12], 2011	PTA: Pre-transplant vs post-transplant (n = 71)	Proteinuria and estimatedGFR (eGFR)	Up to 4 yr	Overall, proteinuria decreased from 1.36 (SD 2.72) g/d pre-transplant to 0.29 (0.51) g/d post-transplant (P < 0.01) eGFR decreased by about 20% from 94 (39) mL/min per 1.73m2 to 75 (22) mL/min per 1.73 m2 (P < 0.01)
Diabetic neuropathy
Havrdova et al[13], 2016	SPK: Pre-transplant vspost-transplant (n = 12)	Epidermal nerve fiberdensity on skin biopsy, autonomic function tests, and nerve conduction studies	Up to 8 yr	No improvement in epidermal nerve fiber density or functional deficits on autonomic function tests
Boggi et al[12], 2011	PTA: Pre-transplant vspost-transplant (n = 71)	Clinical neurologicexamination (vibration threshold), nerve conduction studies, and autonomic function tests (lying-to-standing test)	Up to 4 yr	Significant improvement in mean vibration thresholds, nerve conduction studies, and autonomic function tests after PTA compared with before
Diabetic retinopathy
Boggi et al[12], 2011	PTA: Pre-transplant vs post-transplant (n = 71)	Visual acuity scores andfundoscopic examination	Up to 4 yr	Before transplantation, 7.5% of patients had no retinopathy and remained lesion-free at 4 yr. Of the 29.5% with non-proliferative retinopathy, 75% improved and 25% remained unchanged. In the remainder with proliferative retinopathy, lesions remained stable in 82% and progressed in 18%
Giannarelli et al[14], 2006	PTA (n = 33) vs type 1 diabetes (n = 35)	Visual acuity scores, fundoscopic examination, and angiography in selected cases	Up to 30 mo	Before transplant, 9% of patients with PTA and 6% of those with type1 diabetes had no retinopathy, 24% and 29% had non-proliferative retinopathy, and 67% and 66% had proliferative retinopathy. Overall, the percentage of patients with improved or stabilized retinopathy was significantly higher in the PTA group (P < 0.01)
Koznarova et al[15], 2000	SPK (n = 43) Vs KTA (n = 45)	Visual acuity scores and fundoscopic examination	3 yr	In the SPK group, fundoscopic findings at the end of follow-up had improved, stabilized, or deteriorated in 21.3%, 61.7%, and 17.0%, respectively. In the KTA group these figures were 6.1 %, 48.8%, and 45.1% (P < 0.001)

KTA: Kidney transplant alone; SPK: Simultaneous pancreas-kidney; PAK: Pancreas after kidney.