Outcomes in patients who received organ transplants from donors with melanoma

 From practiceupdate.com

Here is a link.

----------------------------

In this systematic literature review, the authors sought to clarify outcomes in recipients of solid organ transplants from donors with a history of melanoma. Given the shortage of organs available for donation and the long waiting lists, it is important to elucidate the risks to recipients of accepting organs from potentially suboptimal donors such as those with a known history of malignancy.

The authors identified 181 total reported cases of melanoma in organ donors from 17 articles. However, of these, only 41 cases included recipient outcomes. In total, 75 individuals received organs from these 41 donors with melanoma, and of these, a striking 43 (63%) recipients developed melanoma after transplant. Melanoma diagnosis occurred from 3 months to 6 years after transplant, and 24 of these patients died. Follow up of the recipients who did not develop melanoma ranged from 12 months to 5 years, although 11 had no reported follow-up duration and 5 were lost to follow-up.

As expected, given the nature of this retrospective literature review, the quality of data is inconsistent and therefore, inference is limited. As the authors acknowledge, the sample includes only donors with a confirmed melanoma diagnosis. Several excluded cases were suspicious for donor tumor origin but lacked a confirmed donor melanoma diagnosis. Additionally, there was no comparator control group of recipients from donors without melanoma, in whom the rate of de novo melanoma could be compared with the study group to calculate a relative risk.

In spite of these weaknesses inherent to the study design and variable quality of available literature, this article makes an important contribution to our limited understanding of the outcomes in recipients of solid organ transplant from donors with melanoma, highlighting the substantial numbers of melanomas that do develop in recipients, which is likely an underestimate for the aforementioned reasons. Moreover, as might be expected, a substantial mortality rate was observed among recipients who developed donor-associated melanoma in the context of significant iatrogenic immunosuppression.

Importantly, the authors also point out that there are no standardized protocols to check for undiagnosed or unreported history of melanoma in candidate donors, which may help reduce the likelihood of inadvertent transfer of organs from a melanoma-affected source. This article represents a step towards a better understanding of outcomes for this population of potential organ recipients and highlights the need for further study in this arena.