Prevalence and outcomes of cystic lesions of the transplant pancreas: The University of Wisconsin Experience

Abstract

Literature on the behavior of cystic lesions in pancreas transplants is scarce, and hence a better understanding is warranted. Data on recipients and their respective donors that underwent simultaneous kidney and pancreas, pancreas transplant alone, and pancreas after kidney between 1994 and 2015 were reviewed (n = 1185). Cystic lesions of the transplant pancreas developed in 22 patients (1.8%): 12 pseudocysts, 2 cysts/remnants, 4 intraductal papillary mucinous neoplasms (IPMN), 2 adenocarcinomas, 1 low-grade intraepithelial pancreatic neoplasia, and 1 case of polycystic kidney disease. The median size was 3.6 cm (1.6-5.5 cm), and occurred at a median time of 65.5 months (2-183 months) posttransplant. The median age of the graft at time of diagnosis was 42 years (25.7-54.5), with 17 of 22 grafts (77%) functioning at time of diagnosis. Triggers for investigation were elevations in pancreatic enzymes, re-admissions for abdominal pain, and incidentalomas. High-resolution imaging and diagnostic biopsy/aspiration with ancillary tests were the main diagnostic tests. Most pseudocysts were managed by percutaneous drainage, and although no firm inference can be made from such a small series, we have observed that the behavior and management of IPMN and adenocarcinoma in the pancreas graft appears congruent to that of the native pancreas.

Salvage of Graft Pancreas in a Simultaneous Pancreas-kidney Transplant Recipient With Splenic Artery Thrombosis, Infected Walled-off Necrosis, and Stenting of Y Arterial Graft Stenosis

“…We did not perform KRAS and GNAS mutations with TP53 and PIK3CA or PTEN mutations, because neoplasm in the immediate posttransplant period is less likely. 11…”

“…We did not perform KRAS and GNAS mutations with TP53 and PIK3CA or PTEN mutations, because neoplasm in the immediate posttransplant period is less likely. 11 The endovascular approach has a high technical success (>95%) in evading hepatic artery thrombosis following hepatic artery stenosis in orthotopic liver transplantation with an excellent primary assisted patency and decreased need for reintervention. 12 However, literature on the use of stents in TPAS remains scarce.…”

Intraductal papillary mucinous neoplasm in a transplant pancreas: a rare occurrence

“…With the frequent use of high‐resolution imaging in patients throughout their post‐transplant course to investigate abdominal symptoms and laboratory abnormalities, it is not surprising that pancreatic cystic lesions (PCLs) have been more frequently detected in the transplant pancreas in recent years 2 . Prevalence of PCLs in the transplanted pancreas in one large series was 1.8% 3 . Intraductal papillary mucinous neoplasm (IPMN) is a PCL which exhibits risk of progression to invasive carcinoma in the non‐immunosuppressed, over an uncertain time period, estimated to be approximately 5 years 4 .…”

Diffuse Intraductal Papillary Mucinous Neoplasia in Both Native and Transplant Pancreases Despite Normal Residual Pancreas in the Respective First-Degree Donor

“…This case illustrates that an immunocompromised recipient may develop significant cystic transformations in both organs, suggesting an environmental insult given lack of genetic/familial tendency. 1,2 Management of patients with these de novo neoplasms, especially invasive ones, should consider their impaired immunity, comorbidities, and future risk of malignant transformation. 3…”