A Meta-Analysis of the Impact of the Two-Layer Method of Preservation on Human Pancreatic Islet Transplantation

Abstract

There are conflicting reports about the effectiveness of perfluorocarbons used in the two-layer method (TLM) of pancreas preservation for human islet transplantation. The mechanism of action is unclear and the optimal role of this method uncertain. The study design was a meta-analysis of the evidence that TLM improves islet isolation outcomes. Pubmed, CENTRAL, EMBASE, Science Citation Index, and BIOSIS were searched electronically in January 2008. After selecting the relevant human trials for meta-analysis data relating to donor variables, study design, primary and secondary islet isolation outcomes were extracted. Electronic searches identified eight unique citations, describing 11 human studies that were eligible for the meta-analysis. When comparing TLM with preservation in University of Wisconsin (UW) solution, there was a statistically significant higher islet yield [WMD 711.55, 95% confidence interval (CI) 140.03–1283.07] in the TLM group. The proportion of transplantable preparations obtained was not significantly different (OR 1.30, 95% CI 0.89–1.88) between the two groups. The rate of successful islet isolations for marginal organs was higher in the TLM group (OR 6.69, 95% CI 1.80–24.87). Improved oxygenation and preservation of cellular bioengertics is thought to be the main underlying mechanism, although no single mechanism has yet been confirmed. There is currently no clear evidence that the TLM is beneficial in human islet transplantation. It may improve the preservation of marginal organs.