Pancreatic cystic neoplasm prevalence in liver transplantation candidates and post-transplantation outcome

Aims Intraductal papillary mucinous neoplasm (IPMN) inherently carries a risk of degeneration, and little is known about its progression in patients undergoing immunosuppressive therapy (IS) after liver transplantation (LT). The aim of the study was to assess the prevalence and the risk of IPMN progression in transplanted patients.

Methods We retrospectively enrolled patients with IPMN who underwent LT between January 2018 and December 2022. IPMN diagnosis relied on cross-sectional imaging before LT. Follow-up was scheduled with US semiannually in the first year and then annually or with CT/RMN according to clinical needs. Follow-up ended on October 31^st, 2023.

Results During the study period, 760 LTs were performed, and 20 patients presented with IPMN (2.6%). Median age 56 [IQR, 52-63] years, 50% males, BMI 23 [21-27] kg/m², 50% with alcoholic cirrhosis, median MELD score 13 [10-20], 50% with hepatocellular carcinoma (HCC). The median pre-LT Ca19.9 was 35 kUI/L [13-70]. Diagnosis of IPMN was confirmed with CT/RMN 0.9 [0.5-3] years before LT. All patients exhibited branch-duct IPMN (IPMN-BD), with 14/20 (70%) having more than two cysts and 17/20 (85%) involving the head of the pancreas, with a median cyst diameter of 12 [7-18] mm. Two patients (10%) reported worrisome cystic features (>45 mm and growth>5 mm in 2 years, respectively) and underwent endoscopic ultrasound. IS was based on Tacrolimus±Everolimus (30% of patients) according to explant histology. After a median time of 1.5 [0.9-2.6] years since LT, 14/20 (70%) patients had CT/RMN for HCC surveillance or suspected biliary injury and the median post-LT IPMN size was 12 [9-18] mm, with no significant differences compared to pre-LT values (paired p=0.32). After a median follow-up of 2.2 [1.1-4.3] years, 19/20 (95%) patients are alive (1 died due to HCC recurrence). Moreover, none of the patients developed high-risk signs or pancreatic malignancy.

Conclusions Our cohort demonstrated that low risk IPMN-BD do not increase their potential of malignancy during immunosuppressive therapy after LT. Consequently, this type of IPMN seems to require no special management before and after transplantation; however longer follow-up may be helpful to confirm the relative low risk of degeneration of IPMN in LT recipients.

Publication History

Article published online:
15 April 2024