Branch duct intraductal papillary mucinous neoplasm of the pancreas in solid organ transplant recipients

Am J Gastroenterol. 2009 May;104(5):1256-61. doi: 10.1038/ajg.2009.62. Epub 2009 Apr 7.


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.

Publication types

  • Comparative Study

MeSH terms

  • Adenocarcinoma, Mucinous / diagnosis
  • Adenocarcinoma, Mucinous / immunology
  • Adenocarcinoma, Mucinous / mortality
  • Adenocarcinoma, Mucinous / surgery*
  • Aged
  • Analysis of Variance
  • Carcinoma, Pancreatic Ductal / diagnosis
  • Carcinoma, Pancreatic Ductal / immunology
  • Carcinoma, Pancreatic Ductal / mortality
  • Carcinoma, Pancreatic Ductal / surgery*
  • Case-Control Studies
  • Cholangiopancreatography, Endoscopic Retrograde
  • Endosonography
  • Female
  • Humans
  • Immunocompromised Host*
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Organ Transplantation / adverse effects*
  • Pancreatectomy / adverse effects
  • Pancreatectomy / methods
  • Pancreatic Neoplasms / diagnosis
  • Pancreatic Neoplasms / immunology
  • Pancreatic Neoplasms / mortality
  • Pancreatic Neoplasms / surgery*
  • Postoperative Complications / mortality
  • Probability
  • Prognosis
  • Risk Assessment
  • Survival Analysis
  • Transplantation Immunology
  • Treatment Outcome