Record number:
300
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:
Two renal recipients: 18 months in one patient, second recipient underwent transplant nephrectomy approximately 6 months posttransplant and remained free of disease at last followup. (Index patient was liver recipient who developed disease at 6 months).
Alerting signals, symptoms, evidence of occurrence:
Not detected in the donor.
Two renal recipients: (Index patient was liver recipient who developed melanoma at 6 months posttransplant); kidney removed in one, treatment refused by other, the second patient developed widespread melanoma at 18 months.
Liver recipient: 6 months after transplant: abdominal pain and ascites, increase of BUN, creatinine, liver enzymes and total BR. CT scan: enlarged liver. Biopsies and appropriate stains 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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Keywords:
References:
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Case report
Liver transplant
Kidney transplant
Deceased donor
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Expert comments for publication:
Donor died of intracerebral hemorrhage. Authors suggest that suspicion for metastatic tumor, i.e., melanoma, should exist when a clear cause for CNS hemorrhage does not exist. It is not known if that was the case in this donor.