(Case report): Donor derived melanoma in a liver transplant patient (2013)

Status:

Ready to upload

Record number:

1786

Adverse Occurrence type:

Melanoma

MPHO Type:

Liver

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:

Presented to emergency department with abdominal pain, shortness of breath, 1 week low grade fever. Examination showed hepatosplenomegaly and right upper quadrant tenderness. CT showed retroperitoneal lymphadenopathy and innumerable liver masses, mediastinal lymphadenopathy and multiple subcutaneous nodules. Liver biopsy suspicious for PTLD but eventually shown to be melanoma.

Demonstration of imputability or root cause:

No history of melanoma in donor or recipient. DNA fingerprinting of short tandem repeats showed tumor to be of donor origin.

Imputability grade:

3 Definite/Certain/Proven

Groups audience:

Keywords:

altered mental status

CT (computed tomography)

liver biopsy

References:

Donor-derived metastatic melanoma in a liver transplant recipient established by DNA fingerprinting

Suggest new keywords:

case report

malignancy

melanoma

liver transplant

Reference attachment:

Bilal M Donor melanoma in liver transplant patient.pdf

Suggest references:

Bilal M, Eason JD, Das K, Sylvestre PB, Dean AG, Vanatta JM. Donor-derived metastatic melanoma in a liver transplant recipient established by DNA fingerprinting. Exp Clin Transplant. 2013 Oct;11(5):458–63.

Note:

First review done 5/20/18 MN Second review done 5/31/18 MCS

Expert comments for publication:

Patient treated with decreased immunosuppression, temozolomide and thalidomide with partial response; rejection episode resulted in switch from tacrolimus to sirolimus; later reduced. Patient re-presented 8 months after melanoma diagnosis with seizure and altered mental status, CT showed multiple CNS lesions. Whole brain radiation given with temporary improvement but patient died of CNS disease shortly thereafter. Authors note that elderly patients with idiopathic intracranial hemorrhage have highest risk of melanoma transmission.