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Published on: August 2, 2019
Cause of death for heart transplant patients, an autopsy study
Justin Burk1, Cory T Bernadt1, Jon Ritter1
1Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA.
Insights
Autopsy findings in heart transplant patients reveal that nearly half of deaths are allograft-related, with infection being the most common cause. Autopsies remain crucial for understanding patient outcomes and unexpected causes of death.
Area of Science:
- Cardiology
- Transplantation Medicine
- Pathology
Background:
- Heart transplantation is a critical treatment for end-stage heart failure.
- Understanding causes of death and complications post-transplant is vital for multidisciplinary care teams.
- This study reviews autopsy findings in heart transplant recipients to identify trends.
Purpose of the Study:
- To analyze demographic data, causes of death, and autopsy findings in heart transplant patients.
- To identify the proportion of deaths related to the allograft versus other causes.
- To assess the utility of autopsy in evaluating heart transplant recipients.
Main Methods:
- Retrospective review of autopsy reports, photos, and slides from 1990-2023.
- Analysis of demographic, clinical, and pathological data.
- Classification of cause of death (COD) as allograft-related or non-allograft-related.
Main Results:
- 88 heart transplant autopsies were reviewed; 41.1% of deaths were allograft-related, with infection as the most frequent COD.
- Non-allograft-related causes accounted for 58.9% of deaths.
- Six unexpected causes of death were identified, highlighting the value of autopsy in detecting unperceived complications.
Conclusions:
- A significant proportion of heart transplant deaths are linked to the allograft, emphasizing the need for ongoing monitoring.
- Infection is a primary cause of death among allograft-related fatalities.
- Autopsies continue to provide valuable insights into patient mortality and can reveal unexpected findings, aiding in comprehensive patient evaluation.
Introduction:
Heart transplantations are lifesaving for patients with end-stage heart failure. It is pertinent for the multidisciplinary care team to understand how heart transplant patients succumbed to death and the complications that occurred. In this study, we performed a comprehensive retrospective review of all the autopsies performed in our institute for heart transplant patients and report the trend of demographic data, cause of death, and autopsy findings.
Materials And Methods:
Reports, photos, and slides of autopsies performed at our institute from 1990 to 2023 for heart transplant patients were reviewed. Pertinent demographic data (age, gender, pretransplant diagnosis), clinical data (clinical history of rejection, complication, time interval from transplant to death, clinical cause of death) and pathological findings (allograft pathology, infectious etiology, other findings related to cause of death) were reviewed, documented, and analyzed.
Results:
We identified 88 cases, consisting of 53 male and 35 female patients. The median age at transplant was 26 years, while 28.5 years was the median age at death. The median interval from transplant to death was 10 months. The cases were classified in three categories based on length of survival post-transplant: Superacute (<1 month, 21%), Early (1 month-12 months, 30%), and Late (> 12 months, 49%). Slides were unavailable for review in 15 cases, which were excluded from cause of death (COD) evaluation. We categorized 41.1% of cases as allograft-related COD and 58.9% as non-allograft-related COD. Six of the CODs were not perceived premortem. These unexpected CODs included moderate/severe acute cellular rejection in a patient with a recently negative biopsy, dehiscent suture caused by a fungal abscess, an aorto-bronchial fistula, CMV myocarditis, acute abdominal bleeding, and ruptured atherosclerotic plaques with acute myocardial infarction.
Conclusion:
We systematically reviewed 33 years of heart transplant autopsies. We found that 41.1% of deaths were allograft related, with infection being the most frequent COD. While the rate of unexpected findings was low, the findings demonstrate the continued utility of autopsy in patient evaluation.
