Pancreatic cystic lesions in liver transplant recipients
Peter Mačinga Orcid.org 1, Darina Cupalová2, Dana Kautznerová Orcid.org 3, Jiří Froněk Orcid.org 4, Pavel Trunečka5, Julius Špičák Orcid.org 1, Tomáš Hucl Orcid.org 1
1 Klinika hepatogastroenterologie, Transplantcentrum, IKEM, Praha
2 Pracoviště radiodiagnostiky a intervenční radiologie, IKEM, Praha
3 Pracoviště radiodiagnostiky a intervenčníradiologie, IKEM, Praha
4 Klinika transplantační chirurgie, Transplantcentrum, IKEM, Praha
5 Transplantcentrum, IKEM, Praha
Background: Pancreatic cystic lesions (PCLs) are common in the general population and their prevalence increases with age. Pancreatic cystic neoplasia accounts for more than half of all pancreatic cysts. Some of them have malignant potential. Solid organ transplant recipients have an elevated cancer risk due to immunosuppression. The natural course of PCL in solid organ transplant recipients is unknown. Aim and Methods: The purpose of this study was to investigate the prevalence and course of incidental PCL in liver transplant recipients. We performed a retrospective analysis of imaging findings and medical records of all adult patients who underwent liver transplantation in the Institute for Clinical and Experimental Medicine in Prague between September 1996 and November 2014. Results: In total, 967 orthotopic liver transplantations were performed in the study period in 578 males and 389 females (mean age 51 ± 11.7). PCLs were found in 60 patients (6.2%; 26 males, 34 females; mean age 61 ± 8.9), 29 of whom had PCLs before transplantation. The median size of the detected PCLs was 10 mm (range 5–85 mm). PCLs were located in the head (35%), body (33%) and tail (15%) of the pancreas, and 17% of patients had multifocal PCL. Two or more PCLs were present in 20 patients (33%). Mean follow-up duration was 37.5 months (range 6–194). In 10 patients (17%), the size of the lesion increased (mean + 4 mm); however, progression was clinically relevant in none of the patients. Patients with PCLs were significantly older (p < 0.001), more likely to be women (p < 0.05), and were more often transplanted for primary biliary cirrhosis (p < 0.05) and α1-antitrypsin deficiency (p < 0.05). No patient died from PCL during follow-up. There was no significant difference in the survival of patients with and without PCL. Conclusion: PCLs are as frequent in liver transplant recipients as in the general population. Their presence was associated with higher age, female sex, and type of liver disease, but not with patient survival.
Keywordsimmunosuppression, liver transplantation, pankreatická cysta
To read this article in full, please register for free on this website.
Benefits for subscribers
Benefits for logged users
2. Laffan TA, Horton KM, Klein AP et al. Prevalence of unsuspected pancreatic cysts on MDCT. AJR Am J Roentgenol 2008; 191 (3): 802–807. doi: 10.2214/AJR.07.3340.
3. Sahani DV, Kambadakone A, Macari M et al. Diagnosis and management of cystic pancreatic lesions. AJR Am J Roentgenol 2013; 200 (2): 343–354. doi: 10.2214/ AJR.12.8862.
4. Del Chiaro M, Verbeke C, Salvia R et al. European experts consensus statement on cystic tumours of the pancreas. Dig Liver Dis 2013; 45 (9): 703–711. doi: 10.1016/j.dld.2013.01.010.
5. Tanaka M, Chari S, Adsay V et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 2006; 6 (1–2): 17–32.
6. Tanaka M, Fernández-del Castillo C, Adsay V et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 2012; 12 (3): 183–197. doi: 10.1016/j.pan.2012.04.004.
7. Italian Association of Hospital Gastroenterologists and Endoscopists, Italian Association for the Study of the Pancreas, Buscarini E et al. Italian consensus guidelines for the diagnostic work-up and follow-up of cystic pancreatic neoplasms. Dig Liver Dis 2014; 46 (6): 479–493. doi: 10.1016/j.dld.2013.12.019.
8. Spinelli KS, Fromwiller TE, Daniel RA et al. Cystic pancreatic neoplasms: observe or operate. Ann Surg 2004; 239 (5): 651–657.
9. Fernández-del Castillo C, Targarona J, Thayer SP et al. Incidental pancreatic cysts: clinicopathologic characteristics and comparison with symptomatic patients. Arch Surg 2003; 138 (4): 427–433.
10. Herrero JI, Lorenzo M, Quiroga J et al. De novo neoplasia after liver transplantation: an analysis of risk factors and influence on survival. Liver Transpl 2005; 11 (1): 89–97.
11. Aberg F, Pukkala E, Höckerstedt K et al. Risk of malignant neoplasms after liver transplantation: a population-based study. Liver Transpl 2008; 14 (10): 1428–1436. doi: 10.1002/lt.21475.
12. Krynitz B, Edgren G, Lindelöf B et al. Risk of skin cancer and other malignancies in kidney, liver, heart and lung transplant recipients 1970 to 2008 – a Swedish population-based study. Int J Cancer 2013; 132 (6): 1429–1438. doi: 10.1002/ijc.27765.
13. Gill KR, Pelaez-Luna M, Keaveny A et al. Branch duct intraductal papillary mucinous neoplasm of the pancreas in solid organ transplant recipients. Am J Gastroenterol 2009; 104 (5): 1256–1261. doi: 10.1038/ajg.2009.62.
14. Girometti R, Intini SG, Cereser L et al. Incidental pancreatic cysts: a frequent finding in liver-transplanted patients as assessed by 3D T2-weighted turbo spin echo magnetic resonance cholangiopancreatography. JOP 2009; 10 (5): 507–514.
15. Lennon AM, Victor D, Zaheer A et al. Liver transplant patients have a risk of progression similar to that of sporadic patients with branch duct intraductal papillary mucinous neoplasms. Liver Transpl 2014; 20 (12): 1462–1467. doi: 10.1002/lt.23983.
16. Darstein F, König C, Hoppe-Lotichius M et al. Impact of pancreatic comorbidities in patients with end-stage liver disease on outcome after liver transplantation. Eur J Intern Med 2014; 25 (3): 281–285. doi: 10.1016/j.ejim.2014.01.005.
17. Ngamruengphong S, Seeger KM, McCrone LM et al. Prevalence and outcomes of cystic lesion of the pancreas in immunosuppressed patients with solid organ transplantation. Dig Liver Dis 2015; 47 (5): 417–422. doi: 10.1016/j.dld.2015.02.011.
18. Lee KS, Sekhar A, Rofsky NM et al. Prevalence of incidental pancreatic cysts in the adult population on MR imaging. Am J Gastroenterol 2010; 105 (9): 2079–2084. doi: 10.1038/ajg.2010.122.
19. Zhang XM, Mitchell DG, Dohke M et al. Pancreatic cysts: depiction on single-shot fast spin-echo MR images. Radiology 2002; 223 (2): 547–553.
20. Matthaei H, Schulick RD, Hruban RH et al. Cystic precursors to invasive pancreatic cancer. Nat Rev Gastroenterol Hepatol 2011; 8 (3): 141–150. doi: 10.1038/nrgastro. 2011.2.
21. Li A, Wang Y, Deng Z. Concurrent autoimmune pancreatitis and primary biliary cirrhosis: a rare case report and literature review. BMC Gastroenterol 2014; 14: 10. doi: 10.1186/1471-230X-14-10.
22. Epstein O, Chapman RW, Lake-Bakaar G et al. The pancreas in primary biliary cirrhosis and primary sclerosing cholangitis. Gastroenterology 1982; 83 (6): 1177–1182.
23. Rabassa AA, Schwartz MR, Ertan A. Alpha 1-antitrypsin deficiency and chronic pancreatitis. Dig Dis Sci 1995; 40 (9): 1997–2001.
24. Witt H, Kage A, Luck W et al. Alpha1-antitrypsin genotypes in patients with chronic pancreatitis. Scand J Gastroenterol 2002; 37 (3): 356–359.
25. Torra R, Nicolau C, Badenas C et al. Ultrasonographic study of pancreatic cysts in autosomal dominant polycystic kidney disease. Clin Nephrol 1997; 47 (1): 19–22.
26. Veena AB, Rajesh G, Varghese J et al. Alcoholic chronic pancreatitis and alcoholic liver cirrhosis: differences in alcohol use habits and patterns in Indian subjects. Pancreas 2012; 41 (5): 703–706. doi: 10.1097/MPA.0b013e31823b62ca.
27. Spicak J, Pulkertova A, Kralova-Lesna I et al. Alcoholic chronic pancreatitis and liver cirrhosis: coincidence and differences in lifestyle. Pancreatology 2012; 12 (4): 311–316. doi: 10.1016/j.pan.2012.05.008.
28. Farrell JJ, Fernández-del Castillo C. Pancreatic cystic neoplasms: management and unanswered questions. Gastroenterology 2013; 144 (6): 1303–1315. doi: 10.1053/j.gastro.2013.01.073.