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  • Title: Branch duct intraductal papillary mucinous neoplasm of the pancreas in solid organ transplant recipients.
    Author: Gill KR, Pelaez-Luna M, Keaveny A, Woodward TA, Wallace MB, Chari ST, Smyrk TC, Takahashi N, Clain JE, Levy MJ, Pearson RK, Petersen BT, Topazian MD, Vege SS, Kendrick M, Farnell MB, Raimondo M.
    Journal: Am J Gastroenterol; 2009 May; 104(5):1256-61. PubMed ID: 19352341.
    Abstract:
    OBJECTIVES: 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.
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