BRANCHED DUCT INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM (BD-IPMN) OF
PANCREAS IN SOLID ORGAN TRANSPLANT PATIENTSA SINGLE TERTIARY CENTER EXPERIENCE
AUTHOR: Guru Trikudanathan, Usman Barlass, Mustafa Arain, Stuart Amateau, Rajeev
Attam, Martin Freeman, Shawn Mallery.
Background:
Incidentally detected BD-IPMN represents a significant concern for transplant recipients
because of their uncertain malignant potential especially under immunosuppression. There is
very limited data regarding the risk of progression of BD-IPMN in patients undergoing solidorgan transplant.
Aim:
To determine the prevalence of BD-IPMN in solid-organ transplant recipients (in light of chronic
immunosuppression) and describe their clinical course.
Methods:
Consecutive adult patients undergoing solid-organ transplant (liver/kidney/pancreas/heart/lung)
between January 2004 and July 2014 were identified from our transplant database. Patients
with presumed BD-IPMN identified on imaging (MRI, CT and/ or EUS) either prior to/after solidorgan transplant were included in the study. Patients were excluded if they had high-risk cyst
characteristics at initial diagnosis or follow-up of < 6 months. Demographics, relevant
information regarding transplant including indication/immunosuppression and clinical/imaging
characteristics of cyst were extracted. Duration of both clinical and imaging (interval between
first and last imaging) were recorded. Progression of the BD-IPMN was defined as development
of ‘high-risk stigmata’ or ‘worrisome’ features as per the Fukuoka guidelines
Results:
A total of 3151 patients underwent solid organ transplant during the study period. 264 patients
underwent imaging. 41/264 (15.6%) were identified to have possible BD-IPMN. 27 were males,
Median age was 64 years (range 37-78 years). 18 underwent liver, 15 kidney, 5 combined
liver/kidney, 2 pancreas and 1 heart transplant with a mean duration of immunosuppression
exposure of 44.3 months. Mean duration of clinical-follow up was for a period of 45 months (7114 months) and mean duration of imaging follow up was 29 months (6- 83 months). 1/41
(2.4%) with a BD-IPMN, after 68 months of follow up was noted to have pancreatic
adenocarcinoma. 2.4% of patients developed ‘worrisome feature’ (PD dilation to 5 mm) and
7.3% of patients had cyst enlargement to >3 cm without ‘high risk stigmata’ and are under
surveillance without resection. Among the transplant recipients, all-cause mortality was 9.75% in
patients with BD-IPMN and 10.6% in patients without BD-IPMN. None of them died from
pancreatic cancer.
Conclusions:
All-cause mortality of BD-IPMN patients did not differ significantly from those without BD-IPMN
in solid organ transplant patients. Therefore the presence of BD-IPMN should not preclude
patient from undergoing transplant and following transplant, they should undergo surveillance
similar to the immunocompetent patients.