Status:
Ready to upload
Record number:
1919
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Most recent risk assessment for melanoma (Council of Europe, 2022): Due to the very aggressive behaviour of this tumour, it is considered an unacceptable risk for organ donation.
Malignant melanoma in the donor history: Due to the lack of exhaustive data, transplanting organs from donors with treated malignant melanoma must still be considered to be associated with a high transmission risk. If precise donor data about staging, therapy, follow-up and recurrence-free survival are available, and evaluation by the dermato-oncologist concludes there is a low probability of recurrence and metastasis, organ donation might be considered for selected recipients.
Time to detection:
1 year
Alerting signals, symptoms, evidence of occurrence:
Patient received kidney transplant from his brother (zero match). Shortly after transplant, donor/brother developed neurologic deficits and was diagnosed with metastatic melanoma. Patient refused allograft nephrectomy; CT scans were negative until 1 year posttransplant, which showed masses in allograft, hilar nodes, and spleen. Patient underwent allograft nephrectomy, splenectomy, right hemicolectomy. Liver biopsy showed melanoma. Followup CT showed initial disease progression, followed by regression and calcification. Liver biopsy 3.5 years after nephrectomy showed melanin pigment but no tumor. Trial immunosuppression (to prepare for possible retransplant) did not result in tumor reappearance. Kidney was not available and patient expired from unrelated heart disease 11 years after surgery.
Demonstration of imputability or root cause:
Disease in living donor shortly after kidney transplant with identical tumor arising in recipient months later with initial allograft presentation.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
Suggest new keywords:
Case report
Living donor
Kidney transplant
Melanoma
Allograft nephrectomy
Transplantectomy
Reference attachment:
Suggest references:
Kriegshauser JS, Weidenfeld PL, Wochos DN, Williams JW. Auto-Rejection of Renal Donor-Origin Metastatic Melanoma. Radiology case reports. 2006;1(4):149-53.
Note:
Reviewed 7/26/19 OK to upload. MN
Expert comments for publication:
Rare example of tumor regression following allograft nephrectomy and cessation of immunosuppression. Similar isolated instances are recorded in the literature; several examples are cited in this paper. A detailed analysis of the specific immune mechanisms involved with tumor regression (cell analysis, checkpoint inhibitor expression, molecular tumor features) in such cases could provide valuable insight into converting an anecdotal experience into a therapeutic approach.