Case report: Melanoma after kidney transplant (1997)

Record number:

293

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:

9 months

Alerting signals, symptoms, evidence of occurrence:

Kidney recipient 1: 9 months after tx, increase in serum creatinine. Biopsy of the graft shows infiltration with a malignant melanoma with extensive spread. Immunosuppression withdrawn, with spontaneous rejection of the graft and the tumor. No tumor related death. '-Kidney recipient 2: Alerted by the paired kidney recipient, study carried out showing extensive changes consistent with disseminated malignant melanoma in the transplanted kidney, the abdomen. An ultrasound guided renal biopsy of one nodule in the kidney revealed poorly differentiated malignant cells consistent with malignant melanoma. Immunosuppression withdrawn, IFN treatment, graft removed and immunotherapy required. Prolonged immunotherapy eradicated the widespread malignancy, and the patient went on to a successful second renal transplant, with follow-up of over 24 months.

Demonstration of imputability or root cause:

Donor with unknown condition - Two kidney recipients and liver recipient affected. No evidence of transmission in the heart recipient. - Kidney recipient 1: Gene studies determined the origin of the tumor to be donor in type (tumour cells expressed HLA class 1 antigens mismatched in the recipient and mRNA for the costimulator B7, and the cytokines GM-CSF, IL-1 alpha and beta)

Imputability grade:

3 Definite/Certain/Proven

Groups audience:

Keywords: