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Published on: August 13, 2014
Main autopsy findings in liver transplant patients
R S Markin1, S Hollins, R P Wood
1Department of Pathology, University of Nebraska Medical Center, Omaha.
Insights
Autopsy findings in liver transplant recipients reveal frequent infections and graft complications. Infectious complications affected 20 of 22 patients, primarily impacting the lungs and brain, highlighting critical post-transplant care needs.
Area of Science:
- Transplantation Medicine
- Pathology
- Infectious Diseases
Background:
- Orthotopic liver transplantation (OLT) is a life-saving procedure for end-stage liver disease.
- Post-transplant complications significantly impact patient outcomes and graft survival.
- Autopsy studies are crucial for understanding the spectrum of pathology following OLT.
Purpose of the Study:
- To summarize major autopsy findings in patients who underwent orthotopic liver transplantation.
- To identify common complications affecting the hepatic allograft and extrahepatic organs.
- To analyze the incidence of graft rejection, infections, and other pathological changes.
Main Methods:
- Retrospective review of autopsy findings from 22 patients (6 children, 16 adults) post-OLT.
- Analysis of demographic data, post-transplant survival times, and specific pathological changes.
- Categorization of complications including graft rejection, viral infections, and thrombosis.
Main Results:
- Common hepatic allograft changes included graft rejection (13/22), viral infections (11/22), and hepatic arterial thrombosis (6/22).
- Recurrent hepatitis B was observed in 3 patients.
- Infectious complications were prevalent (20/22), predominantly involving the lungs (bronchopneumonia, abscess) and brain (edema, herniation, infection).
Conclusions:
- Infections are a major cause of morbidity and mortality following orthotopic liver transplantation.
- Lungs and brain are frequently affected extrahepatic sites in post-OLT patients.
- Understanding these autopsy findings is vital for improving patient management and survival strategies in liver transplant recipients.
Abstract:
The major autopsy findings from 22 patients (6 children, 16 adults) having undergone therapeutic orthotopic liver transplant are summarized. The mean age for children was 4.2 yr (range 4 mo to 9 yr) and 41 yr (range 20 to 57 yr) for adults. The mean posttransplant survival time in these patients was 16.7 d for children and 72.5 d for adults. The changes present in hepatic allograft included graft rejection (13), viral infections (11), massive necrosis due to hepatic arterial thrombosis (6), and recurrent hepatitis B (3). Infectious complications were present in 20 of 22 patients. The extrahepatic organs primarily involved by infection were lungs and brain. Bronchopneumonia and abscess formation were the most common lung findings, whereas cerebral edema and herniation, and infection occurred in the brain. Cardiac findings included acute myocardial infarction, mycotic mural thrombus and cytomegalovirus myocarditis. The gastrointestinal tract, adrenals, and kidneys were virtually spared. No significant changes were found in the pancreas and urogenital tract.
