Status:
Ready to upload
Record number:
2163
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:
7 months
Alerting signals, symptoms, evidence of occurrence:
3 week history of vomiting, abdominal pain, rigors and fatigue; following admission, CT and MRI scans showed multiple liver lesions and a biopsy confirmed melanoma.
Demonstration of imputability or root cause:
HLA typing identified donor origin of tumor cells in this female recipent of a male islet cell transplant.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
Suggest new keywords:
Malignancy
Case Report
Deceased donor
DBD/donation after brain death
Islet cell transplant
DNA typing
Genetic testing
Melanoma
Therapy discussed
Reference attachment:
Suggest references:
Thomas Foord, James Gilbert, Nick Coupe. Case Study. A Donor Transmitted Melanoma in Pancreatic Islet Cell Transplantation. JNDS Vol. 2 No. 2 (2021): Hilary Term 2021. DOI: https://doi.org/10.37707/jnds.v2i2.131
Note:
Uploaded MN 5/8/22
First review MN 11/11/23
Second review DN Aug 10 2024
Expert comments for publication:
The donor had a history of treated melanoma 7-8 years prior to donation, with no evidence of disease at time of transplant. The authors hypothesize that circulating tumor cells remained dormant and reactivated under the influence of immunosuppression, in line with current thinking regarding melanomas. To our knowledge, this is the first example of melanoma transmitted by this type of transplant,. The patient received pembrolizumab immunotherapy; the final patient outcome is not explicitly stated. The authors present a general discussion regarding donor cancer screening and suggest that it is not practical in a general sense due to the low prevalence of undetected cancer, but may be of use in specific cases, such as in the case of donors with a history of melanoma (e.g., reverse-transcriptase PCR for tyrosinase RNA in donor peripheral blood). However, such studies have not yet been validated in a donor population.