Case report: Melanoma after kidney transplant (2006)

Record number:

296

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:

4.5 months

Alerting signals, symptoms, evidence of occurrence:

One kidney: Four and a half months post-transplant, when the lung transplant recipient was confirmed to have donor origin melanoma, the patient was informed and advised to stop immunosuppression to allow rejection of both the allograft and any donor origin malignant melanoma cells that may be present. Computer tomography scanning of the head, neck, chest, abdomen and pelvis showed no evidence of metastatic disease. Ultrasound of the transplant kidney was unremarkable. Retrospective review of two allograft biopsies performed at the time of transplantation and eight days postx showed no evidence of melanoma or rejection. 2 weeks after stopping the immunosuppression he presented with fever, graft pain, falling urine output and elevated creatinine. A clinical diagnosis of rejection was made and transplant nephrectomy performed. Histology demonstrated vascular and cellular rejection and 3 mm deposit of tumour with central necrosis was present. 2 years post transplant he remained clinically well and there was no evidence of metastatic disease (PET, CT), retx.

Demonstration of imputability or root cause:

Kidney: 3-mm deposit of tumour with central necrosis. Tumour cells were positive for S100 proteins and HMB45, confirming melanoma. There was no evidence of tumour infiltrating lymphocytes to suggest rejection of the melanoma cells.

Imputability grade:

3 Definite/Certain/Proven

Groups audience:

Keywords:

CT (computed tomography)