Fatal transfer of malignant melanoma from multiorgan donor to four allograft recipients

Background. In this report we describe the transfer of malignant melanoma f rom a single donor to four solid organ transplant recipients, all of whom d ied from metastatic melanoma. Methods and Case Histories. The donor of a heart, liver, and two kidneys to four separate recipients died of intracerebral hemorrhage. The donor had n o history or clinical evidence of melanoma, All four recipients, treated wi th standard immunosuppression protocols, developed metastatic malignant mel anoma within 1 year after transplantation. Three patients died within 14 mo nths after transplantation, although the fourth, whose immunosuppressive th erapy was discontinued, died of metastatic melanoma 30 months after renal t ransplantation. Findings: Tumors from all recipients were histologically identical. Donor o rigin of tumor cells was confirmed by polymerase chain reaction (PCR)-based DNA analysis for polymorphic short tandem tetrameric repeats (Geneprint ST R, Promega Corp., Madison, WI). DNAs from nontumorous donor tissue and tumo r tissue available from three recipients tested positive for CSF1P0 alleles 10 and 12 and for TH01 alleles 6 and 7, although DNAs from nonneoplastic r ecipient tissues all exhibited different allelotypes. Interpretation. Transmission of fatal or potentially fatal malignant tumors , notably malignant melanoma, from donor to recipient is an uncommon compli cation of solid organ transplantation. PCR-based genetic analysis permits d efinitive assignment of the source of posttransplant tumors.