PhD Scientific Days 2026

Surgical Medicine

Pancreas and Islet Transplantation versus Insulin Therapy in Type 1 Diabetes undergoing Renal Transplantation: A Systematic Review and Meta-Analysis

Name of the presenter

Marchis, Arnold

Institute/workplace of the presenter

Centre for Translational Medicine, Semmelweis University

Authors

Arnold Marchis¹, Mahmoud Obeidat¹, Yoon Kee Beck¹, Sándor Orbán¹, Georgiosz Kukumzisz¹, Devarajulu Mariyappan¹, Orsolya Dohán¹, Reka Toth¹, Peter Fehervari¹, Titus Augustine², Péter Hegyi¹, Szilárd Váncsa¹, Bálint Erőss¹
1: Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
2: Manchester University Hospitals NHS Foundation Trust, Manchester, UK

Text of the abstract

Type 1 Diabetes (T1D) leads to insulin deficiency and impaired glucose metabolism, causing diabetic nephropathy. Patients require dialysis or renal transplantation and accompanying to restitute adequate glucose metabolism. Options for therapy are pancreas or islet transplantation or insulin therapy. We aimed to assess the efficacy of diabetes therapy following these interventions.

We performed a systematic search of PubMed, EMBASE, and the Cochrane Library on the 17th of November 2024 (PROSPERO: CRD42024610944). We included (single-arm and two-arm) studies that reported on simultaneous pancreas-kidney transplant (SPKT), pancreas-after kidney (PAK), simultaneous islet-kidney (SIK) or islet after kidney, and kidney transplant-alone and insulin (KTA-I). Our primary outcome was the improvement of glycated hemoglobin (HbA1c) from baseline. Furthermore, we investigated C-peptide, fasting glucose, lipid levels, blood pressure, renal function, overall and graft survival. We calculated pooled mean differences (MD) relative to baseline at the follow-up point and where possible, compared to the intervention group, otherwise single means were pooled with 95% confidence intervals (CI). Survival data were pooled and assessed based on individual patient data (IPD) extracted from Kaplan-Meier (KM) curves for overall survival (OS), pancreas (PGS) and kidney graft survival (KGS) using restricted mean survival time (RMST).

Across 286 (single-arm and two-arm) studies, we found simultaneous pancreas-kidney transplant (SPKT) offers a greater reduction in HbA1c (%) levels than KTA-I (MD: -3.2; -5.26, -1.14), and C-peptide (ng/mL) increased more in SPKT (2.76; 2.48, 3.72) compared to SIK/IAK (1.54; 0.16, 2.92). Pancreas transplantation methods offered the highest OS (PAK: 57.3; 55.2, 59.3,), (SPKT: 55.3; 54.6, 55.9). OS was higher in KTA-I (54.9; 53.3, 56.4) than SIK/IAK (46.3; 39.7, 52.9). Patients in the KTA-I group, receiving living-donor kidney (LDK) have better OS and KGS than those receiving deceased-donor kidney (DDK). OS: LDK (104; 98.5,109.4) v DDK (97.1; 91.5, 102.8). KGS: LDK (95.5; 92.3, 98.6) v DDK (82; 76.1, 87.9).

Pancreas transplantation offers better glucose metabolism and patient survival. LDK offers greater overall patient and renal graft survival, than DDK.

Funding
This study was supported by the Semmelweis University Research and Innovation Fund.