Use of anti-inflammatory agents in clinical islet cell transplants: A qualitative systematic analysis

Abstract

Immunologic and non-immunologic loss of islet cells upon their transplantation into the liver leads to suboptimal outcomes. Anti-inflammatory agents are used during autologous and allogeneic transplantation. The aim of this qualitative systematic literature review is to evaluate their clinical use and safety. Electronic databases Embase, PubMed, Cumulative Index for Nursing and Allied Health Literature, ClinicalTrials.gov, and EU Clinical Trials Register were searched. Of the 216 unique citations, 10 with tumor necrosis factor (TNF) blockers [etanercept (ETA) or infliximab] and 3 with both TNF blockers and an interluekin-1 receptor antagonist [anakinra (ANA)]) were included. Of these, 12 were in allogeneic and one in autologous transplant. Insulin independence with decreased islet cells and number of transfusions were reported with their use. One infection was reported in a group receiving ETA. Analysis suggested that the use of ETA ± ANA have the potential to improve outcomes in islet cell transplant.

The role of extracorporeal membrane oxygenation in pediatric abdominal transplant patients: A qualitative systematic review of literature

“…The strength of this study lies in it being the first qualitative systematic analysis published suggestive of usefulness of ECMO in pediatric abdominal organ transplantation. The search was conducted by a qualified expert medical librarian experienced in such Qualitative Systematic Literature (QSL) searches 23,24 . Limitations are similar to other QSL searches, such as the lack of larger cohort studies in the literature, and the inability to fully capture the failure of ECMO in practice if clinicians are less likely to publish negative outcomes.…”

“…The search was conducted by a qualified expert medical librarian experienced in such Qualitative Systematic Literature (QSL) searches. 23,24 Limitations are similar to other QSL searches, such as the lack of larger cohort studies in the literature, and the inability to fully capture the failure of ECMO in practice if clinicians are less likely to publish negative outcomes. The search strategy did not include screening the citations of included articles and articles without abstracts were excluded, thus some studies may have been left out.…”

Clinical islet transplantation: Current progress and new frontiers

“…Hence, anticoagulation and antiplatelet therapies, as well as anti‐inflammatory agents targeting cytokine responses, are now routinely used in clinical IT. The addition of anticoagulants such as heparin 34 and anti‐inflammatory agents such as TNF‐α inhibitors (infliximab and, particularly, etanercept) 22,29,78 and interleukin‐1 inhibitors (anakinra) has shown to improve clinical outcomes in IT 78 . However, two important aspects potentially affecting patient management of IBMIR (e.g.…”

What Is New with Total Pancreatectomy and Autologous Islet Cell Transplantation? Review of Current Progress in the Field

“…Szempruch et al completed a systematic review recently examining the use of different anti-inflammatory agents in islet cell transplantation. Common medications observed in use currently include Etanercept (ETA) and Infliximab, tumor necrosis factor (TNF) blockers and Anakinra (ANA), an interleukin-1 receptor antagonist (IL-1RA) [ 37 ]. Infliximab is now rarely used and typical regimens involve several dosages of combination therapy (ANA + ETA).…”