Objective To evaluate the efficacy and safety of prophylactic octreotide for preventing complications after pancreas transplantation.
Methods We searched The Cochrane Library (Issue 1, 2008), PubMed (1970 to January 2008), EMbase (1974 to January 2008) and CBM (1978 to January 2008). Six studies concerning prophylactic octreotide in preventing complications after pancreas transplantation were retrieved. Study selection and assessment, data collection and analyses were undertaken by two reviewers independently. Meta-analyses were done using The Cochrane Collaboration’s RevMan 4.2.10 software.
Results Three RCTs, involving a total of 82 patients were included in the review. On the fifth postoperative day, the urinary amylase was significantly lower in patients in the octreotide group compared to the control group (SMD=–784.86, 95%CI –1464.24 to –105.49, P=0.02), and no significant difference was observed between the two groups in serum amylase (SMD=–12.26, 95%CI –56.53 to 32.06, P=0.59). No significant difference in the incidence of complications was noted between the two groups. The differences between the two groups in graft survival rate (90 days after operation) and patients’ 6-month survival rate were not statistically significant (RR=0.96, 95%CI 0.83 to 1.11, P=0.56; RR=1.17, 95%CI 0.86 to 1.58, P=0.32, respectively). As for safety, there were no reports of adverse effects of octreotide on CsA or FK506 absorption and no reports of other adverse reactions.
Conclusion The evidence currently available shows that prophylactic octreotide is not capable of reducing dramatically the occurrence of pancreatitis, fistula, thrombosis and rejection after pancreas transplantation. And there is no obvious influence on graft survival rate and patient survival rate. Because the RCTs available for this systematic review are too small, further high-quality large-scale RCTs with long-term follow up are required to provide more reliable evidence.
Citation：
LI Lulu,LI Yongsheng,PANG Lili,ZHAO Na,FENG Li,LI Shengfu,LONG Dan,LI Youping. Efficacy and Safety of Octreotide in Preventing Complications after Pancreas Transplantation: A Meta-Analysis of Randomized Trials. Chinese Journal of Evidence-Based Medicine, 2008, 08(4): 267-272. doi: 10.7507/1672-2531.20080057
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Gruessner AC, Sutherland DER. Pancreas transplant outcomes for United States (US) and non-US cases as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR) as of June 2004. Clin Transplant, 2005, 19: 433-455.
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| 2. |
Humar A, Ramcharan T, Kandaswamy R, et al. The impact of donor obesity on outcomes after cadaver pancreas transplants: Why grafts fail and the risk factors-A multivariate analysis. Transplantation, 2004, 78(8): 1188-1192.
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| 3. |
Cooper M, Wringht F, Smith J, et al. Successful treatment of a high-output fistula with a somatostatin analogue following pancreas transplantation. Transplantation Proceedings, 1989, 21(4): 3738-3741.
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| 4. |
Stratta R, Taylor R, Lowell J, et al. Selective use of sandostatin in vascularized pancreas transplantation. American Journal of Surgery, 1993, 166(6): 598-604.
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| 5. |
Hesse UJ, Meester D, Troisi R, et al. The use of low dose octreotide prophyaxis in pancreatic transplants with enteric drainage. Results of a prospective randomized single center trial. Clin Transplant, 2005, 19(3): 299-303.
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| 6. |
Benedetti E, Coady NT, Asolati M, et al. A prospective randomized clinical trial of perioperative treatment with octreotide in pancreas transplantation. Am J Surg, 1998, 175(1): 14-17.
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| 7. |
Stratta RJ, Taylor RJ, Lowell JA, et al. Randomized trial of Sandostatin prophylaxis for preservation injury after pancreas transplantation. Transplant Proceedings, 1993, 25(6): 3190-3192.
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| 8. |
Bogetti D, Nazatrwski S, Zielinski A, et al. Perioperative treatment with octreotide minimizes technical complications after enteric conversion of bladder-drained pancreas trandplants. Clin Transplant, 2004, 18(2): 137-141.
|
| 9. |
Zielinski A, Nazatrwski S, Bogetti D, et al. Simultaneous pancreas-kidney transplant from living related donor: A single-center experience. Transplantation, 2003, 76(3): 547-552.
|
| 10. |
Wadstrom J, Gannedahl G, Wahlberg J, et al. Persistent pancreatic fistula after pancreas transplantation treated with fibrin glue and octreotide. Transplant Proceedings, 1995, 27(6): 3491-3492.
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| 11. |
张娟, 丁惠国, 尤红, 等. 生长抑素受体亚型在人肝星状细胞的表达及其临床意义. 首都医科大学学报, 2006, 27(4): 441-444.
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- 1. Gruessner AC, Sutherland DER. Pancreas transplant outcomes for United States (US) and non-US cases as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR) as of June 2004. Clin Transplant, 2005, 19: 433-455.
- 2. Humar A, Ramcharan T, Kandaswamy R, et al. The impact of donor obesity on outcomes after cadaver pancreas transplants: Why grafts fail and the risk factors-A multivariate analysis. Transplantation, 2004, 78(8): 1188-1192.
- 3. Cooper M, Wringht F, Smith J, et al. Successful treatment of a high-output fistula with a somatostatin analogue following pancreas transplantation. Transplantation Proceedings, 1989, 21(4): 3738-3741.
- 4. Stratta R, Taylor R, Lowell J, et al. Selective use of sandostatin in vascularized pancreas transplantation. American Journal of Surgery, 1993, 166(6): 598-604.
- 5. Hesse UJ, Meester D, Troisi R, et al. The use of low dose octreotide prophyaxis in pancreatic transplants with enteric drainage. Results of a prospective randomized single center trial. Clin Transplant, 2005, 19(3): 299-303.
- 6. Benedetti E, Coady NT, Asolati M, et al. A prospective randomized clinical trial of perioperative treatment with octreotide in pancreas transplantation. Am J Surg, 1998, 175(1): 14-17.
- 7. Stratta RJ, Taylor RJ, Lowell JA, et al. Randomized trial of Sandostatin prophylaxis for preservation injury after pancreas transplantation. Transplant Proceedings, 1993, 25(6): 3190-3192.
- 8. Bogetti D, Nazatrwski S, Zielinski A, et al. Perioperative treatment with octreotide minimizes technical complications after enteric conversion of bladder-drained pancreas trandplants. Clin Transplant, 2004, 18(2): 137-141.
- 9. Zielinski A, Nazatrwski S, Bogetti D, et al. Simultaneous pancreas-kidney transplant from living related donor: A single-center experience. Transplantation, 2003, 76(3): 547-552.
- 10. Wadstrom J, Gannedahl G, Wahlberg J, et al. Persistent pancreatic fistula after pancreas transplantation treated with fibrin glue and octreotide. Transplant Proceedings, 1995, 27(6): 3491-3492.
- 11. 张娟, 丁惠国, 尤红, 等. 生长抑素受体亚型在人肝星状细胞的表达及其临床意义. 首都医科大学学报, 2006, 27(4): 441-444.
