Extensive multifocal branch duct IPMN of the pancreas after liver transplantation: is surgery justified?

BACKGROUND: Cystic lesions of the pancreas resembling intraductal papillary mucinous neoplasms (IPMN) have been reported to develop in an increased rate following liver transplantation and immunosuppression. The cause for this possible association is thus far elusive. PRESENTATION OF THE CASE: We report on a 60-year-old male patient who developed an extensive multicystic change of the entire pancreas, suspicious for IPMN, under follow-up after liver transplantation for secondary sclerosing cholangitis. A total pancreaduodenectomy with splenectomy was performed. The postoperative histopathological assessment revealed a multifocal branch duct IPMN of the gastric subtype showing low-grade dysplasia. DISCUSSION: In the absence of evidence-based guidelines for the management of suspected IPMNs in liver transplant recipients, each patient’s management should be discussed in detail. CONCLUSION: Prospective studies may help to understand the disease and identify risk factors for malignant transformation in IPMNs after liver transplantation for treatment optimization.