The impact of pancreas transplantation on diabetic complications: A systematic review

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews Pub Date : 2025-01-22 DOI:10.1016/j.trre.2025.100910

Gayathri Giri , Daniel Doherty , Shazli Azmi , Hussein Khambalia , Giuseppe Giuffrida , Zia Moinuddin , David van Dellen

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引用次数: 0

Abstract

Background

Pancreas Transplantation (PT) provides optimal treatment for patients with severe complicated Type 1 Diabetes Mellitus (T1DM). Restoration of beta-cell mass allows return to euglycaemia and insulin independence. We aimed to examine its impact on the secondary complications associated with severe T1DM including diabetic eye disease, neuropathy and cardiovascular disease.

Methods

A database search using MedLINE to identify publications to April 2023 was conducted. Searches were performed using MeSH terms ‘Pancreas Transplantation’ AND ‘Diabetes Mellitus, Type 1’ ‘Diabetic Retinopathy’ OR ‘Heart Disease’ OR ‘Cardiovascular Diseases’ OR ‘Peripheral Vascular Disease’ OR “Amputation’ OR ‘Neuropathy.”

Results

All articles were retrospective with 51.1 % (n = 23) case control studies and 48.9 % (n = 22) cohort studies. 82.2 % (n = 37) examined simultaneous pancreas and kidney (SPK) transplantation and 17.8 % (n = 8) analysed pancreas transplant alone (PTA). Heterogenous outcomes metrics were employed. 15 studies examined diabetic retinopathy (DR) with 53.3 % (n = 8) demonstrated improvements after PT, while the remainder (n = 7) exhibited stabilisation. 16 studies assessed neuropathy and 87.5 % (n = 14) demonstrated beneficial effects of PT on nerve conduction studies, vibration perception threshold or corneal confocal microscopy. There was a positive effect on cardiovascular disease by reduction in the incidence of cardiac events, improvement in metabolic profile and increased left ventricular ejection fraction. 14 studies examined cardiovascular disease (71.4 % (n = 10) improvement; 14.2 % (n = 2) stabilisation; 14.2 % (n = 2) progression).

Conclusion

SPK and PTA have beneficial effects in ameliorating or stabilising diabetes complications. Future work should seek to reduce heterogeneity of outcome metrics assessing T1DM complication profile to facilitate robust comparison of beta-cell replacement interventions.

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胰腺移植对糖尿病并发症的影响：系统综述。

背景：胰腺移植（胰腺移植）是严重合并1型糖尿病（T1DM）患者的最佳治疗方法。β细胞群的恢复使血糖和胰岛素的独立性得以恢复。我们的目的是研究其对严重T1DM相关的继发性并发症的影响，包括糖尿病性眼病、神经病变和心血管疾病。方法：使用MedLINE数据库检索截至2023年4月的出版物。使用MeSH术语“胰腺移植”、“糖尿病1型”、“糖尿病视网膜病变”、“心脏病”、“心血管疾病”、“周围血管疾病”、“截肢”或“神经病变”进行搜索。结果：所有文章均为回顾性研究，其中51.1% （n = 23）为病例对照研究，48.9% （n = 22）为队列研究。82.2% （n = 37）接受胰肾联合移植（SPK）， 17.8% （n = 8）接受单独胰肾移植（PTA）。采用异质性结局指标。15项研究检查了糖尿病视网膜病变（DR）， 53.3% （n = 8）在PT后表现出改善，而其余（n = 7）表现出稳定。16项研究评估了神经病变，87.5% （n = 14）的研究表明PT对神经传导研究、振动感知阈值或角膜共聚焦显微镜有有益作用。通过降低心脏事件的发生率、改善代谢谱和增加左心室射血分数，对心血管疾病有积极影响。14项研究检查了心血管疾病（71.4% (n = 10)）的改善；稳定度14.2% (n = 2)；14.2% （n = 2）进展)。结论：SPK和PTA在改善或稳定糖尿病并发症方面有良好的作用。未来的工作应寻求减少评估T1DM并发症的结果指标的异质性，以促进β细胞替代干预措施的有力比较。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation Reviews IMMUNOLOGY-TRANSPLANTATION

CiteScore

7.50

自引率

2.50%

发文量

审稿时长

29 days

期刊介绍： Transplantation Reviews contains state-of-the-art review articles on both clinical and experimental transplantation. The journal features invited articles by authorities in immunology, transplantation medicine and surgery.