title: The transmission of donor-derived malignant melanoma to a renal allograft recipient.
abstract: The transmission to organ transplant recipients of donor origin malignancy in the allograft has been described. Here we report the transmission of malignant melanoma in a renal allograft transplanted from a multiorgan donor. The lung transplant recipient presented with an allograft lesion that was proven to be melanoma and of donor-origin based on human leukocyte antigen (HLA)-DR typing. One renal allograft recipient was undergoing his second deceased donor renal transplant, having lost his first graft from recurrent IgA nephropathy. He was unsensitized and immunosuppression consisted of tacrolimus, mycophenolate and prednisolone. He achieved stable graft function and there were no episodes of rejection. Four and a half months post-transplant a diagnosis of donor origin melanoma in the lung recipient was made and his immunosuppression was stopped. He presented with clinical rejection two wk later and a transplant nephrectomy was undertaken. Histology demonstrated vascular and cellular rejection and there was a 3-mm melanoma deposit with no evidence of tumour infiltrating lymphocytes. Three years post-transplant he remained clinically well with no evidence of melanoma and received his third deceased donor renal transplant. This was complicated by cellular rejection in the first week treated with methylprednisolone and vascular rejection at day 10 treated with anti-thymocyte globulin. Three months post-transplant he has achieved good allograft function and remains well with no evidence clinically or on imaging of metastatic melanoma. The other renal allograft recipient was receiving his first deceased donor transplant, having end-stage renal failure of uncertain aetiology. His immunosuppression was not stopped until melanoma was proven in the renal allograft pair six months post-transplant and he then presented with clinical rejection six wk later. Transplant nephrectomy was undertaken and histology did not demonstrate melanoma, but severe vascular and cellular rejection was evident. At three-yr post-transplant he remains disease free clinically and on imaging. At present, the cardiac allograft recipient has no evidence of transmitted melanoma. The highest risk of transmission of donor origin melanoma appears to be from donors who are older and have died from an intracerebral haemorrhage. It is likely these donors have metastatic melanoma and their intracerebral haemorrhage is not primary but has occurred in an unrecognized metastatic cerebral deposit. While the occurrence of donor-transmitted malignancy is not common, the outcome is often fatal.
authors.affiliation: Department of Nephrology and Transplantation Services, The Queen Elizabeth Hospital, Central Northern Adelaide Health Service, Woodville, SA, Australia. miltonwilliams@ozemail.com.au
authors.forename: C A
authors.initials: CA
authors.lastname: Milton
authors.forename: J
authors.initials: J
authors.lastname: Barbara
authors.forename: J
authors.initials: J
authors.lastname: Cooper
authors.forename: M
authors.initials: M
authors.lastname: Rao
authors.forename: C
authors.initials: C
authors.lastname: Russell
authors.forename: G
authors.initials: G
authors.lastname: Russ
mesh_terms: D006084:Graft Rejection; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D016040:Lung Transplantation; D008297:Male; D008545:Melanoma / Q000209:etiology*; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011239:Prednisolone / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use; D014019:Tissue Donors; D014184:Transplantation, Homologous
chemical_list: D007166:Immunosuppressive Agents; D011239:Prednisolone; D009173:Mycophenolic Acid; D016559:Tacrolimus