Case report: Melanoma after liver transplant (2009)

Record number: 
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: 
6 months
Alerting signals, symptoms, evidence of occurrence: 
Not detected in the donor. 6 months after tx: addominal pain and ascites, increase of BUN, creatinine, liver enzymes and total BR. CTS: enlarged liver. Biopsies and appropriate stain revealed a metastatic malignant melanoma.
Demonstration of imputability or root cause: 
XX-XY mismatch between donor and recipient (fluorescent in situ hybridation examination of the X and the Y centromere content of 300 tumour cell nuclei). Confirmation of donor transmission of the malignancy by DNA sequence analysis of the tumour cells which matched an archived donor lymph node, but not non-neoplastic recipient DNA. Patient refused treatment or retransplantation and died. The 2 recipients of the kidneys were counseled. One patient elected emergent transplant nephrectomy and remained free of disease two years post transplant nephrectomy (routine positron emission tomogrhapy scan surveillance). No evidence of melanoma was found in the explanted graft. The other patient declined Tx nephrectomy and remained on IMS. 18 months post Tx developed widespread metastatic melanoma and died.
Imputability grade: 
3 Definite/Certain/Proven
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Expert comments for publication: 
Authors suggest that spontaneous intracranial hemorrhage in donor may have represented undiagnosed melanoma.