Addition of a total pancreatectomy and pancreas transplantation in a liver transplant recipient with intraductal papillary mucinous neoplasm of the pancreas.
BACKGROUND
Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are increasingly recognized in clinical practice. There are no published data suggesting a management approach for the potential organ transplant recipient with the incidental finding of this pre-malignant lesion.


METHODS
The recipient was a 65-yr-old man with hepatocellular carcinoma in a background of Laennec's cirrhosis. During evaluation for transplant, he was found to have diffuse IPMN. This patient underwent liver transplantation with a planned simultaneous total native pancreatectomy and pancreas transplant from the same donor.


RESULTS
The patient has had normal liver function and has been free of diabetes and exocrine insufficiency at 18 months post-transplant.


CONCLUSIONS
IPMN in the potential transplant recipient should be managed more aggressively than in the general population because these patients will be committed to life-long immunosuppression. If a total pancreatectomy is contemplated, this is a unique opportunity to replace the pancreas with an allograft at the time of transplantation.
Fridell
Jonathan A
JA
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA. jfridell@iupui.edu
Vianna
Rodrigo
R
Mangus
Richard S
RS
Kazimi
Marwan
M
Hollinger
Edward
E
Joseph Tector
A
A
D002288:Adenocarcinoma, Mucinous / Q000601:surgery*; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000601:surgery*; D002291:Carcinoma, Papillary / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D016035:Pancreas Transplantation / Q000379:methods*; D010180:Pancreatectomy