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

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. Resulsts: T-IPMN-Br patients were younger than the NT-IPMN-Br patients (63 vs. 68years, P0.01). The median duration of follow-up for the groups was similar (29 vs. 28 months, P<NS). CIR were present in 24 (833) of T-IPMN-Br patients and 32 (1857) of NT-IPMN-Br. New CIR were noted in 6 (233) of patients in the T-IPMN-Br group during a median follow-up of 17 months (range, 3-100 months) compared with 4 (257) of patients in the NT-IPMN-Br group (PNS). 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.