PREVALENCE AND CLINICAL SIGNIFICANCE OF PANCREATIC CYSTIC LESIONS IN IMMUNOSUPPRESSED PATIENTS WITH SOLID ORGAN TRANSPLANTATION

초록

Background: Solid organ transplant recipients have an increased risk ofcancer due to immunosuppressive therapy. Pancreatic cystic lesions (PCLs) are increasingly being detected, some with malignant potential. We aimedto determine the prevalence of these lesions and describe their clinicalcourse in these patients. Methods: We identified the presence of pancreatic cystic lesions in a retro-spective cohort of 804 consecutive solid organ transplant recipients from2009 to 2019 and compared lesion characteristics at initial and follow-upimaging, when available. We also compared these features with animmunocompetent control group encompassing patients under surveillancefor greater than 12 months and were matched for age and sex. Results: There were 15 patients in the study group and 60 patients in thecontrol group. Among the solid organ transplant recipients with PCLs, therewere 7 and 8 patients undergoing liver and kidney transplantation, respec-tively. Lesion prevalence was 1.86% (15/805). Median diameter of the lar-gest lesion was 20 mm (range: 0.2–60 mm) and most lesions were benign(9/15, simple cyst or pseudocyst). During follow-up imaging, the cysts sizeremained stable in 79.7%, increased in 6.6%, and decreased in 13.7%.Among patients diagnosed with IPMN (6/15), worrisome features werenoted in one patient at the time of cyst diagnosis. However, due to multiplecomorbidities, the patient received only conservative management. Therewere no significantly different features including the rate of size increase orthe develop ment of worrisome features between the study and control group(p < 0.05). Conclusions: Pancreatic cystic lesions are somewhat common in solidorgan transplant recipients. In lesions without high-risk features, the devel-opment of features worrisome for cancer is rare. These lesions can be man-aged conservatively, and their presence should not affect transplanteligibility.