Outcomes of total pancreatectomy with islet autotransplantation: A systematic review and meta-analysis

Table 1 Risk of Bias assessment for cohort studies using the Newcastle Ottawa Scale

Ref.	Publish year	Study design	Q11	Q22	Q33	Q44	Q55	Q66	Q77	Q88	Total
Adult cohorts
Argo et al[39]	2008	Cohort, R	*		*	*		*	*	*	******(6)
Najarian et al[30]	1980	Cohort, R	*	*	*	*			*	*	******(6)
White et al[31]	2001	Cohort, P	*	*	*	*	*	*	*	*	********(8)
Mokadem et al[32]	2016	Cohort, R	*	*	*	*		*	*		******(6)
Garcae et al[24]	2013	Cohort, P	*	*	*	*		*	*	*	*******(7)
Gruessner et al[33]	2014	Cohort, P	*		*	*		*	*	*	******(6)
Wilson et al[15]	2014	Cohort, R	*		*	*		*	*	*	******(6)
Sutherland et al[16]	2012	Cohort, R	*		*	*		*	*	*	******(6)
Colling et al[35]	2017	Cohort, R	*	*	*	*	**	*	*	*	*********(9)
Ahmad et al[29]	2005	Cohort, R	*		*	*		*	*	*	******(6)
Solomina et al[25]	2017	Cohort, R	*		*	*		*	*	*	******(6)
Wang et al[36]	2013	Cohort, R	*		*	*		*	*	*	*******(7)
Bellin et al[18]	2016	Cohort, P	*		*	*		*	*	*	******(6)
Rabkin et al[37]	1999	Cohort, R	*		*	*		*	*	*	******(6)
Valente et al[41]	1985	Cohort, R	*		*	*		*	*	*	******(6)
Wahoff et al[50]	1995	Cohort, R	*		*	*		*	*	*	******(6)
Garcea et al[51]	2009	Cohort, P	*	*	*	*		*	*	*	*******(7)
Pediatric cohorts
Sutton et al[44]	2010	Cohort, R	*		*	*		*	*	*	******(6)
Chinnakotla et al[17]	2014	Cohort, R	*		*	*		*	*	*	******(6)
Bellin et al[18]	2016	Cohort, R	*	*	*	*		*	*	*	*******(7)
Bellin et al[52]	2010	Cohort, R	*		*	*		*	*		*****(5)

¹Representativeness of the exposed cohort.

²Selection of the non-exposed cohort.

³Ascertainment of exposure.

⁴Demonstration that outcome of interest was not present at the beginning of the study.

⁵Cohort comparability based on design.

⁶Assessment of outcome.

⁷Was follow-up long enough for outcomes to occur.

⁸Follow-up adequacy in terms of completeness.

R: Retrospective; P: Prospective; Q: Question.

Table 2 Methodological quality of case series using the Murad tool

Ref.	Year	Design	Q11	Q22	Q33	Q44	Q55	Q66	Q77	Q88	Overall quality
Fan et al[34]	2017	Case series	Y	Y	Y	N	NA	NA	Y	Y	Good
Toledo-Pereyra et al[40]	1983	Case series	Y	Y	Y	N	NA	NA	Y	Y	Good
Rossi et al[38]	1986	Case series	Y	Y	Y	N	NA	NA	Y	Y	Good

¹Does the patient(s) represent the whole experience of the investigator?

²Was the exposure (diagnosis) adequately ascertained?

³Was the outcome adequately ascertained?

⁴Were other alternative causes that may explain the observation ruled out?

⁵Was there a challenge/re-challenge phenomenon?

⁶Was there a dose-response effect?

⁷Was follow-up long enough for outcomes to occur?

⁸Is the case(s) described with sufficient details to allow other investigators to replicate the research or to allow practitioners maker inferences related to their own practice?

Q: question, Y: Yes, N: No, NA: Not available.

Table 3 Data summary of the included studies

Ref.	Study design	Data collected	Year published	Participants enrolled, n	Patients underwent TPIAT, n	Age, mean (SD)/range, yr	Female sex, n (%)
Adults
Argo et al[39]	Retrospective cohort	2005-2007	2008	26	26	43.8 (2.1)	12 (46)
Najarian et al[30]	Retrospective cohort	1977-1980	1980	18	10	24-57	4 (40)
White et al[31]	Prospective cohort study	1994-1999	2001	37	24	44 (NA)	14 (58)
Mokadem et al[32]	Retrospective cohort	1998-2008	2016	70	57	39.9 (14)	32 (56)
Garcae et al[24]	Prospective cohort study	1990-2012	2013	97	60	43 (NA) 21-65	Unknown
Gruessner et al[33]	Prospective cohort study	2009-2013	2014	61	61	42.2 (1.6)	39 (64)
Fan et al[34]	Case series	2013-2015	2017	32	20	39 (13) 21-58	12 (60)
Wilson et al[15]	Retrospective cohort	2000-2013	2014	166	166	37.3 (1.1) 14-62	75 (67)
Sutherland et al[16]	Retrospective cohort	1977-2011	2012	409	4091	35.3 (0.7) 5-69	301 (74)
Colling et al[35]	Retrospective cohort	2002- 2014	2017	59	59	Unknown	30 (51)
Toledo-Pereyra et al[40]	Case series	1979-1981	1983	6	6	35.5 (6.0) 28-41	1 (17)
Ahmad et al[29]	Retrospective cohort	2000-2004	2005	45	45	39 (NA) 16-62	30 (67)
Solomina et al[25]	Retrospective cohort	unknown	2017	20	20	41 (NA) 15-60	13 (65)
Wang et al[36]	Retrospective cohort	2009-2011	2013	76	76	42.1 (11.4)	Unknown
Bellin et al[18]	Retrospective cohort	2007-2013	2016	49	49	32.8 (7.8)	42 (86)
Rabkin et al[37]	Retrospective cohort	1994-1997	1999	5	5	42 ( NA)	4 (80)
Valente et al[41]	Retrospective cohort	unknown	1985	25	22	Unknown	Unknown
Rossi et al[38]	Case series	1981-1985	1986	10	10	34 (NA) 23-65	6 (60)
Wahoff et al[50]	Retrospective cohort	1977-1995	1995	48	48	35 (NA) 12-60	36 (75)
Garcea et al[51]	Prospective cohort study	1996-2006	2009	85	50	43 (NA) 21-65	26 (52)
Pediatrics
Sutton et al[44]	Retrospective cohort	2000-2009	2010	188	118	31.4 (NA) 15-59	8 (50)
Chinnakotla et al[17]	Retrospective cohort	1989-2012	2014	75	75	13.8 (0.4)	42 (56)
Bellin et al[18]	Retrospective cohort	2000-2014	2016	17	17	6.8 (NA)	9 (53)
Bellin et al[52]	Retrospective cohort	1989-2006	2010	18	18	12.8 (4.08) 5.8-18.9	10 (55.6)

¹Includes 53 children.

NA: Not available.

Table 4 Data summary of the included studies (continued)

Ref.	Pre-operative diabetes, n (%)	Alcohol induced pancreatitis, n (%)	Biliary tract disease, n (%)	Idiopathic pancreatitis, n (%)	Genetic mutation, n (%)	Pancreatic divism, n (%)	Autoimmune pancreatitis, n (%)	Post-operative narcotic independence, n (%)	Post-operative insulin independence, n (%)	Mean percent glycosylated hga1c, %, (SD), range
Adults
Argo et al[39]	Unknown	9 (35)	1 (4)	8 (31)	0	6 (23)	0	3 (60)	0 (0)
Najarian et al[30]	0 (0)	6 (60)	1 (10)	3 (30)	1 (10)1	0 (0)	0 (0)	7 (78)	4 (40) at range 1-38 mo
White et al[31]	0 (0)	8 (18)	2 (5)	13 (30)2	0 (0)	1 (2)	0 (0)	16 (77)	8 (33) transient/3 (13) at writing
Mokadem et al[32]	0 (0)	4 (7)	2 (4)	19 (63)	0 (0)	5 (17)	0 (0)	9 (16)	4 (15)
Garcae et al[24]	Unknown	19 (32)	5 (8)	31 (52)	0 (0)	0 (0)	0 (0)	27 (45)	11 (19)
Gruessner et al[33]	Unknown	7 (11)	0 (0)	45 (73)	10 (16)	0 (0)	0 (0)	43 (71)	12 (19) at range 1-24 mo
Fan et al[34]	Unknown	2 (10)	0 (0)	6 (30)	9 (45)	3 (15)	0 (0)	12 (60) at 6 mo	5 (25) at 12.5 mo	7.4 (0.5)
Wilson et al[15]	14 (13)	3 (3)	0 (0)	84 (75)	15 (13)	10 (9)	0 (0)	91 (55) at 1 yr /121 (73) at 5 yr	62 (38) at 1 yr/45 (27) at 5 yr	6.9 (0.3) 5.85-8.3
Sutherland et al[16]	32 (8)	27 (7)	36 (9)	169 (41)	58 (14)	71 (17)	0 (0)	241 (59) at 2 yr3	123 (30) at 3 yr4
Colling et al[35]	3 (5)	0 (0)	2 (3)	6 (10)	49 (83)	4 (7)	0 (0)	35 (66) at 1 yr	19 (32) at 1 yr
Toledo-Pereyra et al[40]	0 (0)	3 (50)	0 (0)	3 (50)	0 (0)	0 (0)	0 (0)		2 (50) at 20 and 25 mo
Ahmad et al[29]	1 (2)	2 (4)	0 (0)	39 (87)	1 (2)	8 (18)	0 (0)	23 (72) at 5 mo	18 (40) at mean 18 mo
Solomina et al[25]	Unknown	0 (0)	0 (0)	3 (15)	13 (65)	3 (15)	1 (5)	18 (87) at 1 yr	8 (53) at 1 yr
Wang et al[36]	11 (14)	Unknown	Unknown	Unknown	Unknown	Unknown	0 (0)	NA	31 (41) at 6 mo
Bellin et al[18]	2 (4)	0 (0)	13 (27)	18 (37)	4 (8)	11 (22)	0 (0)	22 (46) at 1 yr	21 (45) at 1 yr	6.0 (0.9) at 1 yr
Rabkin et al[37]	0 (0)	0 (0)	0 (0)	5 (100)	0 (0)	0 (0)	3 (60)	4 (80)	3 (60) at median 23 mo	6.43 (1.50) 5.1-8.0
Valente et al[41]	Unknown	Unknown	Unknown	Unknown	Unknown	Unknown	Unknown	Unknown	14 (64) at mean 5 yr
Rossi et al[38]	Unknown	2 (20)	0 (0)	8 (80)	0 (0)	1 (10)	0 (0)	9 (90)	7 (70) at 2 yr
Wahoff et al[50]	2 (4)	9 (19)	8 (16)	27 (56)	0 (0)	2 (4)	0 (0)	31 (81)	13 (34)
Garcea et al[51]	0 (0)	18 (36)	5 (10)	24 (48)	0 (0)	0 (0)	0 (0)	30 (59.8) at 1 yr
Pediatrics
Sutton et al[44]	0 (0)	0 (0)	0 (0)	0 (0)	16 (100)	0 (0)	0 (0)	10 (63) at mean 22 mo	4 (25) at mean 22 mo
Chinnakotla et al[17]	Unknown	0 (0)	0 (0)	21 (28)	41 (55)	0 (0)	0 (0)	13(17)	31 (41)
Bellin et al[18]	0 (0)	0 (0)	0 (0)	2 (12)	14 (82)	1 (6)	0 (0)	17 (100)	14 (82)
Bellin et al[52]	0 (0)	0(0)	1 (6)	7 (39)	7 (39)	3 (17)	0 (0)	11 (61) at median 2.5 (0.2-17.1)	11 (61) at 1 year or longer	6.40 (2.34) 5.0-12.5 at 4.5 (5.2); n = 8

¹Unconfirmed.

²Two identified as idiopathic/trauma.

³61% in pediatric patients.

⁴25% in adults, 55% in pediatric patients.

RC: Retrospective cohort; PCS: Prospective control study; CS: Case series; TPIAT: Total pancreatectomy with islet autotransplantation; NA: Not available.