Prevalence and outcomes of pancreatic cystic neoplasms in liver transplant recipients

Abstract

AIMTo determine the prevalence, characteristics and clinical course of pancreatic cystic neoplasms (PCNs) in liver transplantation (LT) recipients.METHODSWe retrospectively studied consecutive patients who underwent LT between January 1998 to April 2016. Clinical and laboratory data were obtained from patient medical records. Imaging findings on computed tomography and magnetic resonance cholangiopancreatography were reviewed by two radiologists.RESULTSDuring the study period, 872 patients underwent cadaveric LT. Pancreatic cysts were identified in 53/872 (6.1%) and 31/53 (58.5%) were PCNs [28 intraductal papillary mucinous neoplasm (IPMN), 2 mucinous cystic neoplasm (MCN), 1 serous cystadenoma]. Patients with PCNs exhibited less male predominance (55% vs 73%, P = 0.03) compared to patients without pancreatic cysts. Thirteen patients (42%) were diagnosed with PCN pre-LT while 18 patients (58%) developed PCN post-LT. The median size of PCNs was 13mm [interquartile range (IQR) 10-20 mm]. All IPMNs were side-branch type. Most PCNs were found in the head and body of pancreas (37% each), followed by the tail (25%). Five patients underwent further evaluation with endoscopic ultrasound. Progress imaging was performed on 81% of patients. PCNs remained stable in size and number in all but 2 patients. During a median follow up of 39 mo (IQR 26-58 mo), the 2 (6%) patients with MCN underwent pancreatectomy. No PCN patient developed pancreatic adenocarcinoma, while 5 died from illnesses unrelated to the PCN. Among patients without PCN, 1/841 (0.1%) developed pancreatic adenocarcinoma.CONCLUSIONThe prevalence of PCNs in LT recipients was similar to the general population (3.6%, 31/872). Side-branch IPMNs do not appear to have accelerated malignant potential in post-LT patients, indicating the current surveillance guidelines are applicable to this group.

Current Evidence in the Management of Premalignant Cystic Lesions of the Pancreas in Patients Undergoing Liver Transplantation

“…Seven articles described the location of the premalignant lesions, with 38.5% located in the head, 33% in the body, and 20.3% in the tail, and 8.2% of the lesions were multifocal 12–17,22 …”

“…Seven articles described the location of the premalignant lesions, with 38.5% located in the head, 33% in the body, and 20.3% in the tail, and 8.2% of the lesions were multifocal. [12][13][14][15][16][17]22 Most pPCLs studied were branch-duct IPMNs (217 lesions). There were only 9 main pancreatic-duct IPMNs, 2 mucinous cystic neoplastic, and 3 serous cystic neoplastic lesions documented in the articles.…”

“…14,21 Two of the 3 patients had mucinous cystic neoplasms with intermediary dysplasia and low-grade dysplasia. 14 The third patient had branch-duct IPMN adenoma on histology. 21 One patient had an unspecified pancreatic resection.…”

“…The indications for liver transplantation were documented in 8 articles, with hepatitis C cirrhosis (37%), alcohol (14%), hepatitis B (9%), nonalcoholic fatty liver disease (3%), and other causes (37%) of cirrhosis. 2,[14][15][16][17]19,21,22 The type of donor liver that was transplanted was not mentioned in any of the articles.…”

The potential of the malignancy of cystic neoplasms of the pancreas

“…Интересна работа австралийских авторов Liu K et al [25], в которой они оценивают динамику IPMN-BD у пациентов после трансплантации печени, находящихся на иммуносупрессивной терапии. Все кисты были размером менее 2 см.…”