*Purpose: The occurrence of de novo cancer after liver transplant (LT) is a leading cause of post-LT mortality and can be partially attributed to the post-LT medically-induced immunosuppressive state. Pancreatic cancer has an incidence of 7.6 per 100,000 population in North America (0.0076%). It poses a diagnostic challenge post-LT, as symptoms of obstructive jaundice can be initially attributed to biliary complications. We aimed to describe the frequency of post-LT pancreatic cancer and the outcomes in this group.

*Methods: All patients with pancreatic cancer following LT were identified via a retrospective review of the electronic medical records in a large-volume LT center (1992-2019). Patient characteristics and outcomes were described with standard summary statistics.

*Results: 2,200 adult LTs were performed in our institution during the study period and 7 patients with post-LT pancreatic cancer (6 adenocarcinoma, 1 neuroendocrine) were identified (incidence 0.32%). Median age was 66 (range 54-77) years, 4 were male (57.1%) and history of alcohol abuse was found in 3 (42.9%), hepatitis B and C infection in 1 (14.3%) and 3 (42.9%), respectively. Most common clinical manifestations were bilirubinemia in 6 (85.7%), weight loss in 4 (57.1%), abdominal pain in 4 (57.1%), weakness in 3 (42.9%), pancreatitis and hyperglycemia each in 1 (14.3%). Median time from LT to pancreatic cancer diagnosis was 9.2 (IQR 5.4-17.9) years, 6 patients had a tumor in the head of the pancreas and 1 in the tail, and the median tumor size was 4 cm (IQR 3.2-4.2). 3 patients underwent resection and 4 patients underwent palliative care due to unresectable disease. On a median follow-up of 117 (IQR 26-355) days after diagnosis, 3 patients are alive to date (42.9%) (Table 1). Overall median post-LT survival was 9.5 (IQR 6.2-18.3) years.

*Conclusions: Pancreatic cancer has a higher incidence in the LT recipient population than the general population in North America. In LT recipients with delayed presentation of jaundice, pancreatic cancer should be included in the differential diagnosis and early screening is warranted.

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