Branch duct intraductal papillary mucinous neoplasm of the pancreas in solid organ transplant recipients.
OBJECTIVE
In immunosuppressed patients with branch duct intraductal papillary mucinous neoplasm (IPMN-Br) associated with solid organ transplantation, the risk of major pancreatic surgery has to be weighed against the risk of progression to malignancy. Recent studies show that IPMN-Br without consensus indications for resection (CIR) can be followed conservatively. We analyzed the course of IPMN-Br in patients with and without solid organ transplant.


METHODS
We compared clinical and imaging data at diagnosis and follow-up of 33 IPMN-Br patients with solid organ transplant (T-IPMN-Br) with those of 57 IPMN-Br patients who did not undergo transplantation (NT-IPMN-Br). In T-IPMN-Br, we noted pre- and post-transplant imaging and cyst characteristics. This case-control study was conducted in a tertiary-care hospital for patients with IPMN-Br.


RESULTS
T-IPMN-Br patients were younger than the NT-IPMN-Br patients (63 vs. 68 years, P = 0.01). The median duration of follow-up for the groups was similar (29 vs. 28 months, P = NS). CIR were present in 24% (8/33) of T-IPMN-Br patients and 32% (18/57) of NT-IPMN-Br. New CIR were noted in 6% (2/33) of patients in the T-IPMN-Br group during a median follow-up of 17 months (range, 3-100 months) compared with 4% (2/57) of patients in the NT-IPMN-Br group (P = NS). Eleven patients (10 NT-IPMN-Br, 1 T-IPMN-Br) underwent surgery during follow-up. Only one NT-IPMN-Br patient was diagnosed with malignancy; all others had benign IPMN-Br.


CONCLUSIONS
In participants with IPMN-Br, short-term follow-up after solid organ transplant was not associated with any significant change in cyst characteristics suggesting that incidental IPMN-Br, even in the setting of immunosuppression post-transplant, can be followed conservatively.
Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida 32224, USA.
Kanwar Rupinder S
KR
Gill
Mario
M
Pelaez-Luna
Andrew
A
Keaveny
Timothy A
TA
Woodward
Micheal B
MB
Wallace
Suresh T
ST
Chari
Thomas C
TC
Smyrk
Naoki
N
Takahashi
Jonathan E
JE
Clain
Michael J
MJ
Levy
Randall K
RK
Pearson
Bret T
BT
Petersen
Mark D
MD
Topazian
Santhi S
SS
Vege
Michael
M
Kendrick
Michael B
MB
Farnell
Massimo
M
Raimondo
D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D000368:Aged; D000704:Analysis of Variance; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D016022:Case-Control Studies; D002760:Cholangiopancreatography, Endoscopic Retrograde; D019160:Endosonography; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016377:Organ Transplantation / Q000009:adverse effects*; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D011336:Probability; D011379:Prognosis; D018570:Risk Assessment; D016019:Survival Analysis; D014181:Transplantation Immunology; D016896:Treatment Outcome