Status:
Ready to upload
Record number:
2179
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.
Note: In addition to the Council of Europe recommendations, the Eye Bank Association of America excludes potential donors with any history of melanoma from donating keratolimbal tissue (guidelines available at https://restoresight.org/wp-content/uploads/2019/11/Med-Standards-October-10-2019.pdf). The European Eye Bank Association had excluded such donors prior to this case report (guidelines available at https://www.eeba.eu/files/pdf/EEBA%20Minimum%20Medical%20Standards%20Revision%205%20Final.pdf).
Time to detection:
3 months
Alerting signals, symptoms, evidence of occurrence:
Hemorrhagic nodules involving transplanted tissue and eye; CT scan showed 1.8x1.5 cm intraorbital soft tissue mass. Biopsy confirmed melanoma.
Demonstration of imputability or root cause:
Donor subsequently found to have died of metastatic melanoma (and also had breast cancer). Both donor and recipient tumors BRAF negative.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
Suggest new keywords:
Malignancy
Case Report
Deceased donor
Keratolimbal transplant
Ocular tissue transplant
Histologic analysis
Immunohistochemistry
Melanoma
Therapy discussed
Reference attachment:
Suggest references:
Sepsakos L, Cheung AY, Nerad JA, Mogilishetty G, Holland EJ. Donor-Derived Conjunctival-Limbal Melanoma After a Keratolimbal Allograft. Cornea. 2017 Nov;36(11):1415-1418. doi: 10.1097/ICO.0000000000001331. PMID: 28834816.
Note:
Uploaded MN 5/8/22
First review MN 11/21/23
Second review DN Aug 10 2024
Expert comments for publication:
This patient was initially reported elsewhere (Avicenna J Med 7(2):75-77, Apr-Jun 2017; NOTIFY record 2176).The current report is more detailed and documents "dramatic" reduction in tumor size following cessation of immunosuppression, and also notes that followup therapy included excision of the remaining keratolimbal tissue containing the limbal stem cells. Pathologic analysis showed no evidence of residual viable tumor. The patient received a Boston type 1 keratoprosthesis and had no evidence of disease at 13 months following excision of the transplant tissue, with 20/60 visual acuity.
Following report of this case, the Eye Bank Association of America changed their criteria to exclude donors with any history of melanoma from becoming keratolimbal tissue donors. Such exclusion had already been in place in the guidelines of the European Eye Bank Association.