Status:
Ready to upload
Record number:
2199
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Most recent risk assessment for choriocarcinoma (Council of Europe, 2022):
Due to the high transmission and mortality rates, it is considered an unacceptable risk for organ donation in any stage of disease. 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:
7 weeks
Alerting signals, symptoms, evidence of occurrence:
Patient developed nausea, vomiting, abdominal pain. Ultrasound found echogenic liver lesion not confirmed by CT. Chest Xray 3 weeks later showed small lung infiltrate. By 11 weeks the patient was hypodermic and had diffuse pulmonary infiltrates. She died on day 85.
Demonstration of imputability or root cause:
Autopsy showed choriocarcinoma in liver and lungs with no involvement of ovaries or uterus. hCG level was found to be elevated with normal level pre-transplant. Retrospective donor testing showed elevated hCG. The donor was a 36 year old woman who had a history of multiple spontaneous abortions and died of cerebral hemorrhage. Information from other centers showed that both kidney recipients had transplant nephrectomies following abdominal pain and fever and were found to have choriocarcinoma in the allografts. One died of metastatic disease and the other was alive without disease at 5 months. The heart recipient had no evidence of disease at the time of report.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
Suggest new keywords:
Malignancy
Case Report
Deceased donor
Kidney transplant
Kidney recipient
Kidney transplantation
Liver transplant
Liver recipient
Liver transplantation
Heart transplant
Heart recipient
Heart Transplantation
Choriocarcinoma
Therapy discussed
Reference attachment:
Suggest references:
Marsh JW Jr, Esquivel CO, Makowka L, Todo S, Gordon RD, Tzakis A, Miller C, Morris M, Staschak S, Iwatsuki S, et al. Accidental transplantation of malignant tumor from a donor to multiple recipients. Transplantation. 1987 Sep;44(3):449-50. doi: 10.1097/00007890-198709000-00025. PMID: 3307063; PMCID: PMC2952526.
Note:
Uploaded MN 5/13/22
First review MN 5/15/22
second review CLFF 5/16/22 (we could add multiple abortions as hint froms donor history, but I decided not to add because this is selfspeaking and we should not fix awareness of people only on this hint)
I have cloned the record for kidney-choriocacrinoma)/ heart-risk of harm (EP)
Expert comments for publication:
This older (1987) report serves as a prototype of what is recognized as a classic example of a donor at higher risk of harboring an unsuspected choriocarcinoma, namely a woman of childbearing age who died due to nontraumatic cerebral hemorrhage.