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Adverse Occurrence type:
Most recent risk assessment for RCC (Council of Europe, 2015): In the presence of donor RCC, complete resection should be achieved before transplant and the contralateral kidney examined. Then the following applies for risk of transmission: <1 cm + Fuhrman nuclear grade (FNG) I/II = minimal risk; 1-4 cm + FNG I/II = low risk; 4-7 cm + FNG I/II = intermediate risk; >7 cm + FNG I/II = high risk; Any RCC with FNG III/IV = high risk.
Time to detection:
Alerting signals, symptoms, evidence of occurrence:
At 15 years posttransplant: multiple masses found in transplant kidney following ultrasound for right upper quadrant abdominal pain -> nephrectomy-> malignancy (mate kidney normal). Multicentric papillary renal cell carcinoma (CA) at 29 locations of kidney (chromophil-basophilic CA (21), clear cell CA (5), chromophil-eosinophil CA (1), mixed CA (2). Assumption by authors that allograft was predisposed to malignant changes (donor-derived).
Demonstration of imputability or root cause:
Donor-derived RCC arising in and limited to allograft kidney.
Suggest new keywords:
DeLong, M.J.; Schmitt, D.; Scott, K.M.; Ramakumar, S.; Lien, Y.H. Multicentric papillary renal carcinoma in renal allograft Am J Kidney Dis 2003; 42 (2) :381 - 4
need to specify exactly how tumors were detected (Done 7/7/15) ?symptoms or asymptomati/routine scan? add more keywords (Done 7/7/15)
Expert comments for publication:
At 15 years post-transplant this would be considered to be a "donor derived" as opposed to "donor transmitted" tumor.