Background: Due to the burden of immunosuppression, presence of pre-malignant disease may be relative contraindication to liver transplantation (LT). We report a single-center experience of patients with intra-ductal papillary mucinous neoplasms (IPMN) of the pancreas and end-stage liver disease (ESLD) undergoing LT. Methods: Retrospective review of a prospectively collected database. Patients with ESLD and IPMN undergoing LT were included. Pre-transplantation, IPMN was diagnosed by contrast-enhanced radiology. Results: Between January 2002 and November 2013, 11 patients (3 M, 8 F; median age 54 years) with IPMN were listed for LT. IPMN was branch duct (BD-IPMN) in 90.9% patients (10/11) and main duct (MD-IPMN) in 9.1% (1/11). Indications to LT were: primary biliary cirrhosis (PBC) in 36.4% (4/11), hepatitis B virus-related cirrhosis (HBV) in 18.2% (2/11), primary sclerosing cholangitis (PSC) in 18.2% (2/11), cryptogenic cirrhosis (CRYPTO) in 18.2% (2/11), and secondary biliary cirrhosis (SBC) in 9.1% (1/11). Hepatocellular carcinoma (HCC) was present in 18.2% (2/11) cases. Patients (90.9%) with branch duct BD-IPMN underwent LT only and were followed-up with contrast-enhanced radiology every 6 months, while the 1 (9.1%) with MD-IPMN underwent simultaneous LT and total pancreatico-duodenectomy. At a median follow-up of 4 years (range 2-11), no patient with BD-IPMN showed radiologic progression of disease nor developed symptoms of pancreatic disease. Conclusions: Due to improvement in radiologic techniques, pancreatic cystic lesions are being frequently diagnosed in the general population. No information is currently available on outcome of IPMN after LT. Albeit retrospective, the current evidence suggests that BD-IPMN should not contraindicate LT. Larger series and longer follow-ups are strongly favored.
The fate of intra-ductal papillary mucinous neoplasm of the pancreas after liver transplantation
De Simone P;Campani D;Bartolozzi C;Filipponi F.
2014-01-01
Abstract
Background: Due to the burden of immunosuppression, presence of pre-malignant disease may be relative contraindication to liver transplantation (LT). We report a single-center experience of patients with intra-ductal papillary mucinous neoplasms (IPMN) of the pancreas and end-stage liver disease (ESLD) undergoing LT. Methods: Retrospective review of a prospectively collected database. Patients with ESLD and IPMN undergoing LT were included. Pre-transplantation, IPMN was diagnosed by contrast-enhanced radiology. Results: Between January 2002 and November 2013, 11 patients (3 M, 8 F; median age 54 years) with IPMN were listed for LT. IPMN was branch duct (BD-IPMN) in 90.9% patients (10/11) and main duct (MD-IPMN) in 9.1% (1/11). Indications to LT were: primary biliary cirrhosis (PBC) in 36.4% (4/11), hepatitis B virus-related cirrhosis (HBV) in 18.2% (2/11), primary sclerosing cholangitis (PSC) in 18.2% (2/11), cryptogenic cirrhosis (CRYPTO) in 18.2% (2/11), and secondary biliary cirrhosis (SBC) in 9.1% (1/11). Hepatocellular carcinoma (HCC) was present in 18.2% (2/11) cases. Patients (90.9%) with branch duct BD-IPMN underwent LT only and were followed-up with contrast-enhanced radiology every 6 months, while the 1 (9.1%) with MD-IPMN underwent simultaneous LT and total pancreatico-duodenectomy. At a median follow-up of 4 years (range 2-11), no patient with BD-IPMN showed radiologic progression of disease nor developed symptoms of pancreatic disease. Conclusions: Due to improvement in radiologic techniques, pancreatic cystic lesions are being frequently diagnosed in the general population. No information is currently available on outcome of IPMN after LT. Albeit retrospective, the current evidence suggests that BD-IPMN should not contraindicate LT. Larger series and longer follow-ups are strongly favored.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
