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A case of intraductal papillary mucinous neoplasm developing in the native pancreas after pancreas transplantation treated by total pancreatectomy

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Abstract

Post-transplant patients reportedly have a higher risk of de novo neoplasms. However, intraductal papillary mucinous neoplasm (IPMN) of the native pancreas after pancreas transplantation (PTx) has not been well investigated. The choice of treatment, especially invasive treatment, for de novo neoplasms in transplant patients should consider their impaired immunity. In this context, we present a case of IPMN developing in the native pancreas of a PTx patient. A 53-year-old man underwent a follow-up abdominal computed tomography scan 6 years after a simultaneous pancreas-kidney transplant for type 1 diabetes mellitus with end-stage diabetic nephropathy requiring hemodialysis. The scan revealed IPMN in the pancreas head; an enhancing internal solid component suggested a high risk of malignancy, indicating surgical resection. Partial pancreatectomy or pancreaticoduodenectomy was anatomically indicated, but considering the insulin-secreting ability of the transplanted pancreas and the potential high risk of postoperative pancreatic fistula due to immune impairment after partial pancreatectomy, total pancreatectomy (TP) was performed. The patient is alive with good pancreas graft function, no signs of indigestion for 18 months after TP, and no evidence of IPMN recurrence. This report should help clinicians characterize de novo IPMN in the native pancreas and determine IPMN therapeutic options for transplant patients.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan

    Hiromichi Sato, Yoshito Tomimaru, Hirofumi Akita, Shogo Kobayashi, Kazuki Sasaki, Yoshifumi Iwagami, Daisaku Yamada, Takehiro Noda, Kunihito Gotoh, Hidenori Takahashi, Tadafumi Asaoka, Masahiro Tanemura, Yuichiro Doki & Hidetoshi Eguchi

  2. Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan

    Hiromichi Sato & Naoki Hama

  3. Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka, Japan

    Toshinori Ito

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  1. Hiromichi Sato
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  2. Yoshito Tomimaru
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Corresponding author

Correspondence to Shogo Kobayashi.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008(5).

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Informed consent was obtained from all patients included in the study.

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Sato, H., Tomimaru, Y., Akita, H. et al. A case of intraductal papillary mucinous neoplasm developing in the native pancreas after pancreas transplantation treated by total pancreatectomy. Clin J Gastroenterol 14, 1766–1771 (2021). https://doi.org/10.1007/s12328-021-01517-0

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  • DOI: https://doi.org/10.1007/s12328-021-01517-0

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