Transmission of Donor Melanoma to Multiple Organ Transplant Recipients

Abstract

Malignant melanoma represents the most common tumour responsible for donor-derived post transplan-tation malignancies. We report the varied presentation and outcome of three graft recipients (two kidney and hepatic) who developed metastatic melanoma following cadaveric organ transplantation from a single multiorgan donor. Two of the recipients presented with symptomatic metastatic lesions and the third patient , despite being carefully monitored, developed evidence of metastatic cutaneous melanoma. Two of the patients died as a direct result of their melanomas. The recipients of corneal and cardiac grafts remain disease-free. We conclude that despite careful screening , donor-derived tumours remain a not uncommon clinical entity. The identification of a lesion in one recipient should prompt immediate examination and investigation of the remaining recipients of multiorgan donations. A 42-year-old Caucasian female who had died in a local hospital from a subarachnoid haemorrhage was the organ donor. The donor HLA type was HLA A: 1,2; B: 60,14; DR: 4,13. The donor had a diagnosis of grade II cervical intraepithelial neoplasia 8 years previously, however , clinical examination was unremarkable at the time of donation. Her family consented for multiorgan trans-plantation including the kidneys, liver, heart and corneas. At the time of organ retrieval no intra-abdominal or in-trathoracic abnormalities were noted and no autopsy was performed. Recipient 1 The recipient of the first kidney, a 55-year-old Caucasian female with a lifelong history of pyelonephritis, had been maintained on haemodialysis for 2 years before transplan-tation. Her tissue type was HLA A: 2,3; B: 7,44; DR: 4,13 and the mismatch was 1 : 2 : 0. Postoperatively she experienced good immediate graft function and received immunosuppression with tacrolimus (Prograf ® , Fujisawa, Osaka, Japan)-based triple therapy (tacrolimus, azathio-prine and prednisolone). No antibody induction therapy was instituted. At 3 months post-transplantation the patient had normal renal function and the protocol renal biopsy performed was reported as normal. However 6 months post-transplantation, the patient had an emergency admission with severe abdominal pain and vomiting. Routine haematological and biochemical investigations were unremarkable as was a plain abdominal X-ray. Upper and lower gastrointestinal endoscopy were performed with no abnormalities visualized. During the admission the patient became increasingly confused , however, the CT scans of the head and thorax and abdomen performed were nondiagnostic. In view of the persisting symptoms a laparoscopy was performed which demonstrated numerous black plaques on the peri-toneal surface of the abdominal wall and on the omentum. Multiple biopsies were taken and the histological examination was compatible with metastatic melanoma. Post-operatively the patient's skin and mucosal surfaces were reexamined but no site of primary melanoma was identified. The antitumour management consisted of the withdrawal of immunosuppression...

Melanoma in Organ Transplant Recipients: Clinicopathological Features and Outcome in 100 Cases

“…and BCC, where the excess risk is in the order of 50-100-fold and 10-fold, respectively (19,20), with a resulting reversal in the usual SCC:BCC ratio of 1:3-4 seen in the general population (21)(22)(23) (24)(25)(26)(27)(28)(29). Only one study has previously addressed outcome in OTRs with a pre-existing melanoma and the limited data similarly suggest a poor prognosis (24).…”

Donor-Derived Metastatic Melanoma in a Liver Transplant Recipient Established by DNA Fingerprinting

“…4 The diagnosis of malignancy in an organ recipient should prompt immediate investigations of other recipients from the same donor in multiorgan donations. 3 In conclusion, donor-derived malignancies are rare, and metastatic melanoma is one such cancer with the highest transmission and mortality rates. Donors should undergo strict screening to minimize such transmission.…”

“…1 Metastatic melanoma is a lethal donor-derived malignancy with a transmission rate of 74% and a mortality rate of 58%. 2 To date, only 4 case reports of metastatic melanoma involving liver allografts [3][4][5][6] were reported in search of the literature.…”

Extended Survival by Urgent Liver Retransplantation after Using a First Graft with Metastasis from Initially Unrecognized Donor Sarcoma

“…Reports of melanoma transmission resulting in disseminated disease in organ transplant recipients have been published (3). Other cancers known to be transmitted from donor to recipient include tumors of neuroendocrine origin, prostate carcinoma, choriocarcinoma, advanced renal carcinoma and lung cancer (4).…”