First World Consensus Conference on Pancreas Transplantation

The First World Consensus Conference on Pancreas Transplantation was convened in Pisa, Italy, from October 17 to 19, 2019, to establish comprehensive evidence-based guidelines for the practice of pancreas transplantation. To avoid potential conflicts of interest, deliberations on issues regarding the impact of pancreas transplantation on the management of diabetes were taken by an independent jury, according to the Zurich-Danish model. Recommendations on technical issues were instead decided by a group of experts, and were validated using the Appraisal of Guidelins for REsearch and Evaluation II (AGREE II) instrument. Two rounds of discussion and voting occurred online, using the Delphi method (agreement rate ≥85%). Recommendations were finalized after live discussions. Quality of evidence was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) methodology and each recommendation received a Grade of Recommendations Assessment, Development and Evaluation (GRADE) rating. A total of 35 queries were identified for jury deliberations and 109 for experts’ recommendations. Forty-nine jury deliberations were delivered and 110 experts’ recommendations were approved. In general, the level of evidence was quite low. No statement was GRADE 1A, because no meta-analysis of prospective and randomized trials exists for pancreas transplantation. Twenty-three of 49 Jury deliberations could not be graded. The remaining 26 deliberations were rated GRADE 2B (n = 22) and GRADE 2C (n = 4). Fifty-one of 110 expert recommendations could not be graded. The remaining 59 recommendations were rated GRADE 1B (n = 13), GRADE 1C (n = 2), GRADE 2A (n = 2), GRADE 2B (n = 20), and GRADE 2C (n = 22). In Jury deliberations both simultaneous pancreas-kidney and pancreas transplant alone were considered to prolong survival, ameliorate the course of chronic complications of diabetes, and improve quality of life. It is hoped that information provided by this consensus conference could be of help for further diffusion and safer practice of pancreas transplantation.