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Adverse Occurrence type:
Most recent risk assessment for melanoma (Council of Europe, 2018): donors with active melanoma represent an unacceptable risk for organ donation. Donors with a history of treated melanoma are generally considered to represent a high transmission risk. Opinions vary. The SaBTO/UK states that a superficial spreading melanoma with tumor thickness less than 1.5 mm and with curative surgery and cancer free interval of more than five years is associated with a low transmission risk, although this conclusion is based on a small number of cases. UNOS/DTAC considers all patients with a history of melanoma to represent a high risk for transmission.
Time to detection:
Alerting signals, symptoms, evidence of occurrence:
Abdominal pain and acute graft functional deterioration led to CT scan that showed pathologic fractures of L1 and L3 with multifocal iliac bone lytic lesions
Demonstration of imputability or root cause:
Bone biopsy showed melanoma; HLA typing of tumor cells showed XY karyotype (patient was female). Recipients of contralateral kidney and corneas from same donor also developed melanoma.
Suggest new keywords:
Singh P, Pandey D, Rovin B, Pesavento TE, Olencki T. Successful Treatment and Five Years of Disease-free Survival in a Donor Transmitted Metastatic Melanoma with Ipilimumab Therapy. Cureus. 2019;11(5):e4658.
Please clone record for cornea transplant MPHO type, reference is made to another recipient who developed melanoma after receiving donor cornea. - OK done (EP)
Expert comments for publication:
The main point of the paper is the successful use of ipilimumab (anti-CTLA-4) for the control of melanoma in this renal recipient. Two other additional reports of successful use (Chen et al. Case Rep Transplant 2012, 2012:1-3, Boyle et al. Transplant Proc. 2017, 49:1551-1554) are referenced. The possibility of triggering rejection must be considered, but should be weighed against the dismal prognosis of melanoma in these patients.