Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2017; 23(48): 8526-8532
Published online Dec 28, 2017. doi: 10.3748/wjg.v23.i48.8526
Prevalence and outcomes of pancreatic cystic neoplasms in liver transplant recipients
Ken Liu, Vikram Joshi, Louise van Camp, Qi-Wei Yang, Judith E Baars, Simone I Strasser, Geoffrey W McCaughan, Avik Majumdar, Payal Saxena, Arthur J Kaffes
Ken Liu, Qi-Wei Yang, Simone I Strasser, Geoffrey W McCaughan, Arthur Kaffes, Sydney Medical School, The University of Sydney, NSW 2006, Australia
Ken Liu, Vikram Joshi, Judith E Baars, Simone I Strasser, Geoffrey W McCaughan, Avik Majumdar, Payal Saxena, Arthur J Kaffes, AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
Louise van Camp, Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
Author contributions: Liu K, Baars JE, Kaffes AJ, Saxena P, Strasser SI, Majumdar A and McCaughan GW conceived and designed the research; Liu K, Joshi V, Yang QW and van Camp L acquired the data; Liu K analyzed and interpreted the data; Liu K and van Camp L drafted the article; Liu K, van Camp L, Joshi V, Yang QW, Baars JE, Strasser SI, Majumdar A, Saxena P, McCaughan GW, Majumdar A critically revised the article; all authors read and approved the final version.
Institutional review board statement: The study was reviewed and approved by the Sydney Local Health District Human Research Ethics Committee (X15-0426 & LNR/15/RPAH/570).
Informed consent statement: As this is a large retrospective study of over 800 patients, it was not feasible to obtain informed consent. All patient data are anonymized and therefore risk of identification is low.
Conflict-of-interest statement: All authors have no conflicts of interest to declare with respect to this work.
Data sharing statement: No additional data are available
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Arthur J Kaffes, FRACP, MBBS, Associate Professor, Sydney Medical School, University of Sydney, AW Morrow Gastroenterology and Liver Centre, Level 9, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, NSW 2050, Australia. arthur.kaffes@sydney.edu.au
Telephone: +61-2-95162033 Fax: +61-2-95160778
Received: October 28, 2017
Peer-review started: October 30, 2017
First decision: November 21, 2017
Revised: November 27, 2017
Accepted: December 13, 2017
Article in press: December 13, 2017
Published online: December 28, 2017
Abstract
AIM

To determine the prevalence, characteristics and clinical course of pancreatic cystic neoplasms (PCNs) in liver transplantation (LT) recipients.

METHODS

We retrospectively studied consecutive patients who underwent LT between January 1998 to April 2016. Clinical and laboratory data were obtained from patient medical records. Imaging findings on computed tomography and magnetic resonance cholangiopancreatography were reviewed by two radiologists.

RESULTS

During the study period, 872 patients underwent cadaveric LT. Pancreatic cysts were identified in 53/872 (6.1%) and 31/53 (58.5%) were PCNs [28 intraductal papillary mucinous neoplasm (IPMN), 2 mucinous cystic neoplasm (MCN), 1 serous cystadenoma]. Patients with PCNs exhibited less male predominance (55% vs 73%, P = 0.03) compared to patients without pancreatic cysts. Thirteen patients (42%) were diagnosed with PCN pre-LT while 18 patients (58%) developed PCN post-LT. The median size of PCNs was 13mm [interquartile range (IQR) 10-20 mm]. All IPMNs were side-branch type. Most PCNs were found in the head and body of pancreas (37% each), followed by the tail (25%). Five patients underwent further evaluation with endoscopic ultrasound. Progress imaging was performed on 81% of patients. PCNs remained stable in size and number in all but 2 patients. During a median follow up of 39 mo (IQR 26-58 mo), the 2 (6%) patients with MCN underwent pancreatectomy. No PCN patient developed pancreatic adenocarcinoma, while 5 died from illnesses unrelated to the PCN. Among patients without PCN, 1/841 (0.1%) developed pancreatic adenocarcinoma.

CONCLUSION

The prevalence of PCNs in LT recipients was similar to the general population (3.6%, 31/872). Side-branch IPMNs do not appear to have accelerated malignant potential in post-LT patients, indicating the current surveillance guidelines are applicable to this group.

Keywords: Pancreatic cystic neoplasm, Intraductal papillary mucinous neoplasm, Mucinous cystic neoplasm, Liver transplantation, Pancreatic adenocarcinoma, Immunosuppression

Core tip: The prevalence of pancreatic cystic neoplasms (PCNs) in liver transplantation (LT) recipients is similar to that of the general population and PCNs do not appear to behave more aggressively in this setting. Our results suggest that current surveillance guidelines can be safely applied in the immunosuppressed LT population.