Status:
Ready to upload
Record number:
2028
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:
1 year
Alerting signals, symptoms, evidence of occurrence:
Patient complained of fatigue at 1 year posttransplant visit. Increased creatinine was found, donor-specific antibodies were detected and kidney biopsy performed. The diagnosis of B cell leukemia was initially made on the kidney biopsy.
Demonstration of imputability or root cause:
Follow up bone marrow biopsy showed leukemic blasts and molecular genetic HLA subtyping demonstrated donor HLA type.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
Suggest new keywords:
Malignancy
Case report
Kidney transplant
Deceased donor
DNA typing
Cytogenetic analysis
Leukemia, lymphocytic, acute lymphoblastic
Reference attachment:
Suggest references:
Cassol CA, Hod-Dvorai R, Hubbell C, Aggarwal V, Sinha S, Gentile T, et al. Donor-derived Philadelphia chromosome-positive B cell lymphoblastic leukemia presenting with renal allograft involvement in the first year posttransplant. Am J Transplant. 2019;19(3):956-7.
Note:
MN review 4/19/20
Expert comments for publication:
Hematologic studies showed that this malignancy was positive for the t(9;22) Philadelphia chromosome translocation. Therefore, this would not be considered to be a PTLD of donor cell origin, but instead represents transmission of a donor malignancy. Interestingly, the recipient of the contralateral kidney did not develop tumor. The patient reported here received chemotherapy and stem cell transplant (detailed in report) without allograft nephrectomy and was in remission with a functioning allograft 11 months after diagnosis.