Retransplantation of a cardiac allograft inadvertently harvested from a donor with metastatic melanoma.
Donor-derived melanoma is easily transmitted through organ transplants and is highly aggressive in transplant recipients. The best treatment-withdrawal or reduction of immunosuppression-permits tumor rejection but risks allograft rejection. In recipients of nonrenal allografts, the prognosis is particularly grim, with transmission rates and mortality approaching 100%. Retransplantation has been proposed as a possible strategy but has never been performed for a cardiac allograft. This is the first report of cardiac retransplantation and only the second case of retransplantation of any nonrenal organ. Our patient received a heart transplant from a donor found to have occult metastatic melanoma at autopsy. He underwent retransplantation 17 days later. Close clinical and radiographic follow-up reveal no evidence of melanoma 22 months after transplantation. Based on the rapid development of donor-derived melanoma in previous reports, our patient is likely to remain free of donor cancer. Retransplantation and low-dose immunosuppression may have been lifesaving.
Loren
Alison W
AW
Division of Hematology/Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. 19104. awakoff@mail.med.upenn.edu.
Desai
Shashank
S
Gorman
Robert C
RC
Schuchter
Lynn M
LM
D006338:Heart Neoplasms / Q000556:secondary*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008545:Melanoma / Q000556:secondary*; D008875:Middle Aged; D012086:Reoperation; D014019:Tissue Donors; D014184:Transplantation, Homologous