Natural history and management of IPMN in solid organ transplant patients: is it any different?

Intraductal papillary mucinous neoplasms (IPMNs) are premalignant lesions with established surveillance and surgical resection guidelines. This systematic review aims to provide evidence-based guidance for managing IPMNs in transplant patients.

A search of MEDLINE, Embase, and Scopus identified studies published between January 1, 2004, and July 31, 2024, describing transplant candidates or recipients with IPMNs. Covidence software was used to screen and synthesize articles. Data were reviewed to determine whether IPMNs should preclude transplant, delay listing, require different surveillance, necessitate adjusted immunosuppression, or affect surgical complexity or cancer conversion rates.

Seventeen studies involving 7023 transplant patients, including 339 with suspected or confirmed IPMNs (4.82 %), were analyzed. No evidence suggested IPMNs should preclude transplant candidacy or delay listing. IPMN surveillance guidelines for transplant patients should align with those for non-transplant patients. Transplant recipients did not experience higher rates of IPMN conversion to pancreatic cancer, indicating no need to modify immunosuppression.

This qualitative systematic review found no evidence that the natural history or management of IPMNs differs between transplant and non-transplant patients, suggesting no need for special management in transplant populations.