*Purpose: Transplant recipients have a higher incidence of risk-adjusted malignancy than the general population, likely due to immunosuppression. The evaluation of a potential transplant candidate includes age appropriate screening for malignant and pre-malignant conditions. Imaging done during the pre-transplant workup may identify incidental findings, some of which are risk factors for malignancy. Certain pancreatic cysts are associated with risk of harbor pancreatic cancer, a relatively rare but highly morbid condition. Data is severely limited, and no guidelines exist for management of pancreatic cysts in the specific population of potential kidney transplant candidates. Small case series cite a high yield from endoscopic ultrasound (EUS) and selective diagnostic fine needle aspiration (FNA).

*Methods: A retrospective analysis of all adult patients undergoing evaluation for kidney transplantation over two years at a single center was performed to evaluate the frequency of pancreatic cysts and recommended management in this cohort.

*Results: Of the total 805 patients evaluated for kidney transplant, 10 patients were referred for further workup of a pancreatic cyst. Mean age of the group with a pancreatic cyst was 60.7 +/- 11 years (mean +/- SD), and 70% were male. Pancreatic cysts were most commonly identified incidentally on a CT scan (60%) or ultrasound (30%) of the abdomen. All patients with a pancreatic cyst underwent further workup with MRI (with or without contrast) of the abdomen and discussion at multi-disciplinary conference, which resulted in a recommendation for EUS or EUS/FNA in 50% of the group. Average cyst size was 20 mm (range 8 to 46 mm), with 60% located in the pancreatic head or uncinate. The most common diagnosis was side-branch intraductal papillary mucinous neoplasm, and one patient was identified to have a mucinous cystic neoplasm. One of 5 patients undergoing EUS experienced a bleeding complication. In those patients who had a pancreatic cyst identified during evaluation, the outcome of the workup for pancreatic cyst did not change the overall decision to list for transplantation.

*Conclusions: Overall, the incidence of pancreatic cysts identified in this cohort is on par with published rates observed in age-matched individuals. While some reports advocate for the use of EUS and EUS/FNA in patients with pancreatic cyst(s) who are undergoing kidney transplant evaluation, we present an approach for selective application of EUS or EUS/FNA.

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