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:
One kidney: Four and a half months post-transplant, when the lung transplant recipient was confirmed to have donor origin melanoma, the patient was informed and advised to stop immunosuppression to allow rejection of both the allograft and any donor origin malignant melanoma cells that may be present. Computer tomography scanning of the head, neck, chest, abdomen and pelvis showed no evidence of metastatic disease. Ultrasound of the transplant kidney was unremarkable. Retrospective review of two allograft biopsies performed at the time of transplantation and eight days postx showed no evidence of melanoma or rejection. 2 weeks after stopping the immunosuppression he presented with fever, graft pain, falling urine output and elevated creatinine. A clinical diagnosis of rejection was made and transplant nephrectomy performed. Histology demonstrated vascular and cellular rejection and 3 mm deposit of tumour with central necrosis was present. 2 years post transplant he remained clinically well and there was no evidence of metastatic disease (PET, CT), retx.
Demonstration of imputability or root cause:
Kidney: 3-mm deposit of tumour with central necrosis. Tumour cells were positive for S100 proteins and HMB45, confirming melanoma. There was no evidence of tumour infiltrating lymphocytes to suggest rejection of the melanoma cells.
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Expert comments for publication:
Lung recipient also had melanoma; second renal recipient and heart recipient had no evidence of tumor.