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:
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.
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
Research background

Debilitating abdominal pain and diabetes mellitus are hallmark clinical manifestations of chronic pancreatitis (CP). Current management strategies revolve around pain mitigation and treatment of endocrine failure. One available treatment option is total pancreatectomy with islet cell auto transplantation (TP-IAT). Although several studies have suggested a promising role of TP-IAT in CP patients; minimal systematic evidence has been collected on the effect of this procedure on endocrine failure and pain relief in patients with CP.

Research motivation

Emerging data from multiple studies highlight that TP-IAT results in considerable pain relief and insulin independence; however, systemic evidence from high-quality studies is limited.

Research objectives

We performed a systemic review and meta-analysis to evaluate clinical outcomes such as pain control and glucose intolerance following TP-IAT.

Research methods

A comprehensive literature search spanning Pubmed, EMBASE, and Cochrane databases was performed from inception to March 2019. Studies conducted on outcomes of TP-IAT in patients with CP were identified. Comprehensive meta-analysis software was used to extract and analyze data. 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.

Research results

Our meta-analysis evaluated a total of 1100 patients across 21 studies. We found that TI-IAT results in narcotic independence in over 50% of adult and pediatric patients with CP. IAT results in meaningful islet cell function with insulin independence noted in almost one-third of adults and nearly half of pediatric patients following surgery.

Research conclusions

TP-IAT results in acceptable narcotic independence and preservation of beta cell function.

Research perspectives

Long-term prospective studies with clear definitions of patient populations, surgical procedures, and post-surgical care are needed to definitively evaluate insulin and narcotic independence before and after surgery.