Accidental transplantation of malignant tumor from a donor to multiple recipients.

Recently an ancient pathway in transplantation was accidentally retrod when a malignant tumor that was undiagnosed in the lifetime of a cadaveric multiple organ donor was transplanted to several recipients of various organs. The following is an account of the subsequent tragic events. Case Report. A 36-year-old woman died of an apparent spontaneous cerebral hemorrhage. Her past medical history was significant only for multiple spontaneous abortions. Her liver, heart, and kidneys were transplanted into four different recipients in three different transplant centers. The liver recipient. The liver was transplanted on April 25, 1986, into an 18-year-old woman whose native liver had been destroyed by non-A, non-B chronic active hepatitis. Her operation and postoperative course were unremarkable, and she was discharged 27 days later with normal liver function tests on cyclosporine 450 mg twice a day, prednisone 15 mg a day, hydralazine 50 mg four times a day, clonidine 0.1 mg twice a day, and furosemide 40 mg a day. Seven weeks postoperatively on June 19, 1986, the patient began having nausea, vomiting, and abdominal pain, but no fever. She was readmitted to the hospital. Chest roentgenogram, blood analyses, lumbar puncture, and cholangiogram were normal. The graft vessels were patent by ultrasonography. The ultrasound detected an echogenic area in the right lobe of the liver not confirmed by computerized tomography. Her symptoms continued, and a repeat chest roentgenogram obtained on July 8, 1986, showed a small infiltrate in the right middle lobe. Although the patient was still afebrile and the sputum culture showed normal flora, cefazolin was started empirically. On July 13, eleven weeks after transplantation, the patient began to complain of shortness of breath, dyspnea on exertion, and hypoxemia, with an arterial p02 of 47 mmHg. A diffuse interstitial and alveolar pulmonary infiltrate compatible with an opportunistic infection rapidly developed, but a specific diagnosis could not be established. The patient was placed on a ventilator. Repeat computerized tomography now showed an area of inhomogeneity in the posterior portion of the right lobe of the liver. She died on July 19, 1986, 85 days after transplantation. The findings at autopsy included a technically perfect transplantation with no evidence of graft rejection. A malignant trophoblastic tumor (choriocarcinoma) was present in the right lobe of the liver and extensively throughout both lungs. There was no evidence of tumor in the ovaries or the uterus, and there were no products of conception in the uterus, fallopian tubes, or ovaries. Stored preoperative serum and postmortem serum from the recipient were then analyzed for beta human chorionic gonadotropin (B-HCG). Preoperatively, the results were nega-