Is the finding of cystic lesions on the Pancreas in an organ donor, raising the spectre of Intraductal papillary mutinous neoplasm, become a contraindication to the pancreas being used for transplantation
Dearly respected Sir
Thank you very much for the important question. Considering the use of a pancreas with cysts, it is not absolutely a contraindication, the matter is to weigh the risk of transforming to malignancy during the natural course or due to the effect of immunosuppressive therapy, on the other hands, cystic lesions are usually benign. A careful assessment by imaging and cytology, and discussion (multi-specialty team) with the recipient is vital regarding this difficult decision. In cystic fibrosis the results are encouraging in kidney-pancreas and other organs transplantation.
Not an absolute contraindication but many factors need consideration e.g residual pancreatic function [exo and endocrine] in spite of the cyst, presence of malignancy in the cyst, size of cyst, cyst being part of multisystem disease e.g. cystic fibrosis. There is also some chance of development of cyst in the post transplant pancreas so this fact should also be considered
Very difficult decision to make... we had this recently in an, otherwise, pristine mid fifties SPK donor and there were several cysts- some could have been branch duct IPMN but also a couple of 4mm could have been main duct IPMN.
A recent publication in Gut form Germany concluded: 'The follow-up data showed a progress in one-third, suggesting that the mid-term risk of pancreatic cysts is low, but relation of any long-term risk cannot be concluded from the presented data.'
I believe the questions to answer are: what would be the impact of immunosuppression? Will patients agree with regular follow up? And what will the plan be in case we identify increasing in size cysts? The transplant pancreatectomy is not as straightforward as the native.. Should we take the risk?
It is necessary to have a firm diagnosis between being and malignant lesions before taking tis decision
Just to add to the discussion, the recent data from Tanaka that patients who had a resection for IPMN, have higher risk for developing IPMN or even pancreatic adenocarcinoma in the remnant. Difficult decision
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