Adverse Occurrence type:
Most recent risk assessment for melanoma (Council of Europe, 2018): donors with active melanoma represent an unacceptable risk for organ donation. Donors with a history of treated melanoma are generally considered to represent a high transmission risk. Opinions vary. The SaBTO/UK states that a superficial spreading melanoma with tumor thickness less than 1.5 mm and with curative surgery and cancer free interval of more than five years is associated with a low transmission risk, although this conclusion is based on a small number of cases. UNOS/DTAC considers all patients with a history of melanoma to represent a high risk for transmission.
Time to detection:
Alerting signals, symptoms, evidence of occurrence:
Kidney recipient 1: 9 months after tx, increase in serum creatinine. Biopsy of the graft shows infiltration with a malignant melanoma with extensive spread. Immunosuppression withdrawn, with spontaneous rejection of the graft and the tumor. No tumor related death. '-Kidney recipient 2: Alerted by the paired kidney recipient, study carried out showing extensive changes consistent with disseminated malignant melanoma in the transplanted kidney, the abdomen. An ultrasound guided renal biopsy of one nodule in the kidney revealed poorly differentiated malignant cells consistent with malignant melanoma. Immunosuppression withdrawn, IFN treatment, graft removed and immunotherapy required. Prolonged immunotherapy eradicated the widespread malignancy, and the patient went on to a successful second renal transplant, with follow-up of over 24 months.
Demonstration of imputability or root cause:
Donor with unknown condition - Two kidney recipients and liver recipient affected. No evidence of transmission in the heart recipient. - Kidney recipient 1: Gene studies determined the origin of the tumor to be donor in type (tumour cells expressed HLA class 1 antigens mismatched in the recipient and mRNA for the costimulator B7, and the cytokines GM-CSF, IL-1 alpha and beta)
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