[5] Autopsy Findings in Hospitalized Renal Transplant Recipients

R Bhat, AM Kumar, S Soundararajan. Drexel University College of Medicine, Philadelphia, PA

Background: Graft and patient survival has greatly improved over the last few years due to immune modulation. Deaths in these patients are commonly related to the severity of immunosuppression. Our aim in this study was to determine the principal cause(s) of death based on post-mortem findings in kidney transplant patients.
Design: Autopsy records of Hahnemann University Hospital were reviewed from 1999 to 2008. 20 renal and simultaneous renal-pancreas transplant autopsies were retrieved. The cases were classified according to cause of death, post-transplant time, and histologic findings in the transplanted kidney at autopsy.
Results: The mean range of the patients ranged from 34-82 years. The most common indications for the transplant were hypertension and diabetes mellitus.

Table 1: Cause of death in hospitalized renal transplant recipients

Cause of death		Time post-transplant (Range)	Number of cases
Sepsis		3 wks-10 yrs	9/20
Hemorrhage	1. S/p renal procedure	1-4 yrs	3/20
	2. Ruptured allograft	5 days	1/20
	3.Hemorrhagic pancreatitis	5 wks	1/20
	4. S/p non-renal procedure	2 yrs	1/20
Sudden cardiac death		48 hrs-4 yrs	2/20
Coagulopathy	1. Disseminated Intravascular Coagulation	24 hrs	1/20
	2. Metastatic pancreatic carcinoma	3 yrs	1/20
	3. Cerebrovascular accident	9 yrs	1/20

Conclusions: In our study, hemorrhagic complications were the second most common cause of death in renal transplant patients, after sepsis. The most common findings in the transplanted kidney were acute tubular injury/acute tubular necrosis, with no evidence of cellular rejection.
Category: Autopsy

Monday, March 9, 2009 8:30 AM

Platform Session: Section H1, Monday Morning