Causes of Death and Major Autopsy Findings in Liver Transpant Patients – A 35 Case Cohort Study
Brandon Shetuni, Nikolay Dimov, Wanying Zhang, Haonan Li, M Sambasiva Rao, Guang-Yu Yang. Northwestern University, Chicago, IL
Background: Liver transplantation is the second-most common type of solid organ transplant in the USA and recipients are at risk for a variety of serious complications. In the present study, we identified 35 autopsy cases in patients with liver transplant and extensively analyzed the causes of death and major morphologic findings, in order to gain insight regarding prevalent life-ending events, and identify possible preventable complications.
Design: 35 full adult autopsies in patients with history of liver transplant were identified through searching the autopsy database (1996-2012). Reasons for transplantation, survival data, autopsy-determined causes of death, and major morphologic findings were assessed.
Results: Twenty-six patients were male and 9 were female (32-71 y/o). Mean survival was 33 months post-transplant (range 1 day-23 years). Reasons for transplant inclduded viral hepatitis progressing to cirrhosis and/or hepatocellular carcinoma (18 cases), alcohol-cirrhosis (6), amyloidosis (2), primary sclerosing cholangitis (PSC) (2), non-alcoholic steatohepatitis cirrhosis (1), and cryptogenic cirrhosis (6). Twelve patients had short-term survival (<1 month), with causes of death in this group being operative complications and transplant failure (6), cardiac arrest (4), intracranial hemorrhage (1), and acute respiratory failure (1). Superimposed sepsis was seen in only 2 cases. Of 23 patients surviving >1 month, 11 expired from bacterial, viral or fungal sepsis, 5 from gastrointestinal bleeding complications, 2 from cardiac arrest, 1 from complications of esophageal carcinoma, 1 from transplant failure, and remainder (3) from multifactorial causes. Of 18 patients with viral hepatitis prior to transplant, recurrent infection was noted in 5 biopsies, although contribution to death was thought to be insignificant. Likewise, in two cases where rejection was noted, it was not felt to be a major death contributor. Decreased levels of coagulation factors were detectable 1-3 months antemortem in patients dying from hemorrhagic complications. Recurrent malignancies were not identified.
Conclusions: Operative complications were a relatively minor contributor to mortality, likely reflecting improvement in surgical technique. Cardiac arrest was mainly an early post-operative period cause of death, while overwhelming infections were death culprits > 1 month following transplant. It is noteworthy that bleeding events were among most frequent causes of mortality, indicating that diligent attention to transplant synthetic function may be beneficial for early detection of possible fatal complications.
Wednesday, March 6, 2013 9:30 AM
Poster Session V # 6, Wednesday Morning