Status:
Ready to upload
Record number:
2197
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Most recent risk assessment for choriocarcinoma (Council of Europe, 2022):
Newly diagnosed choriocarcinoma: Due to the high transmission and mortality rates, it is considered an unacceptable risk for organ donation in any stage of disease.
Donors with a history of choriocarcinoma: Due to the reported high transmission and mortality rates, it is considered to be associated with a high or unacceptable risk for transmission through organ donation, depending on the recurrence-free period prior to donor death.
Time to detection:
8 months
Alerting signals, symptoms, evidence of occurrence:
Ultrasound surveillance for possible recurrent hepatocellular carcinoma in this male patient transplanted for tyrosinemia and hepatocellular carcinoma. At that time, mild weight loss, gynecomastia, mild edema, morning nausea. Followup CT showed four pulmonary lesions.
Demonstration of imputability or root cause:
Initial biopsy was interpreted as hepatocellular carcinoma. Inquiry regarding donor disclosed 42 year old female who died from cerebral hemorrhage. Recipient of kidney from this donor had died of tumor presumed to be choriocarcinoma. The liver recipient was found to have elevated beta-HCG levels. Treatment was changed and subsequent histsologic examination confirmed choriocarcinoma.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
Suggest new keywords:
Malignancy
Case Report
Deceased donor
Liver transplant
Choriocarcinoma
Hepatocellular carcinoma
Therapy discussed
Reference attachment:
Suggest references:
Pessanha I, Heitor F, Furtado E, Campos AP, Gonçalves I. Long-term survival after choriocarcinoma transmitted by liver graft: A successful report in pediatric transplantation. Pediatr Transplant. 2022 Feb;26(1):e14135. doi: 10.1111/petr.14135. Epub 2021 Sep 5. PMID: 34486207.
Note:
Uploaded MN 5/13/22
First review MN 3/23/24
Second review AE 25/05/2024
Expert comments for publication:
This case report highlights several significant items. First, the physicians apparently became suspicious when the tumor in this liver recipient, first presumed to represent recurrent hepatocellular carcinoma arising shortly after transplant, did not respond to therapy. Inquiry regarding the donor revealed that she was 42 years old and had died of intracerebral hemorrhage. A renal recipient from this donor had expired due to cancer presumed to be choriocarcinoma. To the outside observer, it appears there could be improvements to the system of notification, and that these physicians could have been notified of this situation prior to their own inquiry. Second, the authors note that beta-HCG levels would be a useful donor screening test, considering the circumstances of donor death. A recent publication from the ILTS-SETH Consensus Conference strongly recommends beta-HCG determination in female donors of childbearing age who die as a result of unexplained intracranial hemorrhage (Dominguez-Gil, B, Moench K, Watson C, et al. Prevention and Management of Donor-transmitted Cancer After Liver Transplantation: Guidelines From the ILTS-SETH Consensus Conference. Transplantation 2022;106(1):e12-e29) (NOTIFY record #2183). Thirdly, this report documents the successful treatment of this typically lethal complication with complete remission at 11 year follow-up.