Transplant Melanoma: An Emerging Recipient Risk.
Erica C Rushing, Venkatesh Krishnamurthi, Carol Farver, Ralph Tuthill. The Cleveland Clinic Foundation, OH
Background: Aggressive donor transmitted melanoma is an emerging recipient risk. Malignant melanoma is the most common malignancy transmitted to transplant recipients comprising an estimated 28% of allogenic tumors. Any patients with a known history of melanoma are excluded from donation, so all donors that transmit malignancy have no prior history of disease. Here we report on 5 patients, all organ recipients, who acquired a highly aggressive melanoma from a 32 year old female donor.
Design: The authors conducted a retrospective search of patients, within our institutional anatomic pathology database, with a pathologic diagnosis of “metastatic melanoma” of unknown primary origin between 1999 and 2008. Three cases of metastatic melanoma of unknown primary origin diagnosed after organ transplant were identified and prompted further chart review, histopathologic review of autopsy findings, review of donor registry information, and discussion with transplant and clinical care physicians.
Results: Five patients, all organ recipients, acquired widespread metastatic melanoma from one 32 year old female donor. A review of the donor chart showed that the donor died suddenly from an intracranial hemorrhage, had no known history of melanoma and did not have an autopsy to confirm her cause of death. The lung and heart transplant recipients both presented with respiratory distress and died of multi-system organ failure within two months of receiving their transplanted organs. Their cause of death, widespread aggressive metastatic melanoma, was identified by autopsy at our institution. PCR testing of autopsy tissue from the lung recipient showed the tumor to be derived from the donor organ. The remaining 3 organ recipients (pancreatic, kidney and liver) also presented within 3 months of their transplants with diffuse metastatic disease.
Conclusions: This report of 5 patients, all organ recipients, who acquired a previously undiagnosed, highly aggressive melanoma from a young multi-organ donor, presents some of the diagnostic, pathologic and clinical dilemmas associated with the emergent organ donation process.
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 117, Tuesday Morning