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A comparison of long‐term outcomes of portal versus systemic venous drainage in pancreatic transplantation: a systematic review and meta‐analysis
Author(s) -
Oliver Joseph B.,
Beidas AbdelKareem,
Bongu Advaith,
Brown Lloyd,
Shapiro Michael E.
Publication year - 2015
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12588
Subject(s) - medicine , meta analysis , glycemic , cochrane library , transplantation , pancreaticoduodenectomy , surgery , gastroenterology , pancreas , insulin
Pancreas transplantation venous effluent can be drained via the portal vein or the systemic circulation; however, no recommendation exists for the ideal technique. A systematic review of the literature from 1989 through 2014 using P ub M ed, CINHAL , and C ochrane L ibrary for portal versus systemic venous drainage was undertaken. Only studies on humans and published in E nglish were considered. Measures of glycemic control and total cholesterol were synthesized for meta‐analysis utilizing random‐effects models. Of 166 articles retrieved, 15 articles were included for meta‐analysis. Patient and graft survival were comparable in a large database study as well as in the only randomized control study. No differences in complications were seen when exocrine drainage was enteric for the systemic venous group. Fasting insulin (−34.13 pmol/mL, p < 0.001) was significantly lower within the portal drained group; however, fasting blood glucose levels (−3.4 mg/dL, p = 0.32) and hemoglobin A1C levels (mean difference 0.124%, p = 0.25) were comparable. Total cholesterol levels (−3.62 mg/dL, p = 0.447), as well as other measures of lipids, showed no difference. Based on this systematic review and meta‐analysis, there is no evidence of differences in outcomes or metabolic control in patients undergoing pancreatic transplant with portal venous drainage compared to the systemic venous drainage.