A patient with systemic lupus erythematosus after renal transplantation undergo pancreatoduodenectomy for pancreatic adenocarcinoma- A case report

Introduction: Incidence of pancreatic cancer is increased in the systemic lupus erythematosus (SLE) patients, especially in the patients which are concomitant with renal transplantation. However, the feasibility of performing a pancreaticoduodenectomy for this special group of patients are still uncertain.Results: We present a case of a 44-year-old man suffered from SLE and renal transplantation previously and newly diagnosed as pancreatic head cancer due to a neoformation of the tumor in pancreatic head of the maximum diameter of 38 mm. The lesion was borderline resectable at preoperatory imaging. The patient was subjected to pancreaticoduodenectomy combined with resection and reconstruction of the superior mesenteric vein. Histological examination showed a moderate to low differentiated pancreatic adenocarcinoma pT2N1. The postoperative course was regular. In the silico analysis, we found that the ratio of CD4+ memory activated T cell in this case was higher than that in TCGA and PACA-AU datasets. Furthermore, the patient had higher proportion of CD4+ memory activated T cell in the lymph node than that in patients of GSE103787 (P<0.05). In addition, we found that the expressions of interleukin-2 (IL-2), interferon gamma (IFNG), IL12B and IL4 in this patient were significantly higher than those in PACA-AU dataset.Discussion: SLE patients with renal transplantation are routinely considered to be immune compromised. However, severe infection did not occur in this case by the use of prophylactic anti-infective antibiotics and human gamma globulin. Furthermore, the tumor microenvironment in this case seemed to be more inclined to anti-tumor immunity (with higher proportion of CD4+ memory activated T cell and higher expression of IL-2, IFNG and IL12B).Conclusions: In summary, the case documents the feasibility of a SLE patient with kidney transplantation to tolerate pancreaticoduodenectomy and describes its special anti-tumor immune microenvironment in silico analysis.