NHETS - Necropsy Heart Transplantation Study

Abstract

BackgroundDiscrepancies between pre and post-mortem diagnoses are reported in the literature, ranging from 4.1 to 49.8 % in cases referred for necropsy, with important impact on patient treatment.ObjectiveTo analyze patients who died after cardiac transplantation and to compare the pre- and post-mortem diagnoses.MethodsPerform a review of medical records and analyze clinical data, comorbidities, immunosuppression regimen, laboratory tests, clinical cause of death and cause of death at the necropsy. Then, the clinical and necroscopic causes of death of each patient were compared.Results48 deaths undergoing necropsy were analyzed during 2000-2010; 29 (60.4 %) had concordant clinical and necroscopic diagnoses, 16 (33.3%) had discordant diagnoses and three (6.3%) had unclear diagnoses. Among the discordant ones, 15 (31.3%) had possible impact on survival and one (2.1%) had no impact on survival. The main clinical misdiagnosis was infection, with five cases (26.7 % of discordant), followed by hyperacute rejection, with four cases (20 % of the discordant ones), and pulmonary thromboembolism, with three cases (13.3% of discordant ones).ConclusionDiscrepancies between clinical diagnosis and necroscopic findings are commonly found in cardiac transplantation. New strategies to improve clinical diagnosis should be made, considering the results of the necropsy, to improve the treatment of heart failure by heart transplantation.

Clinically latent and autopsy-verified inflammatory disorders and malignant tumours in transplant patients

“…The frequency of unexpected findings in transplant cases has only been addressed by few systematic autopsy studies 10 12–15 19–21. Previously unknown post-transplant malignancies constitute relevant missed diagnoses 28 29.…”

“…In our large cohort of transplant cases, the frequency of class I discrepancies was relatively low (3%). In the last two decades, few studies on autopsies in transplant patients have evaluated discrepancies between clinical diagnoses and autopsy findings 10 12–15 17 19 21. The Goldman classification was not used in all studies, but class I rates of 31% (n=15/48) for heart transplantation and 10.5% (n=2/19) for liver transplantation were reported 14 21.…”

“…In the last two decades, few studies on autopsies in transplant patients have evaluated discrepancies between clinical diagnoses and autopsy findings 10 12–15 17 19 21. The Goldman classification was not used in all studies, but class I rates of 31% (n=15/48) for heart transplantation and 10.5% (n=2/19) for liver transplantation were reported 14 21. One study on lung transplantation did not use the Goldman classification 10.…”

“…These include diagnoses which would potentially have led to a change of therapy and/or longer survival 9. Apart from case reports, there are some larger cohorts on autopsy findings in transplant patients 10–23. Previous studies often focus on one particular transplant organ or on particular complications, such as infections 10–23.…”

“…Apart from case reports, there are some larger cohorts on autopsy findings in transplant patients 10–23. Previous studies often focus on one particular transplant organ or on particular complications, such as infections 10–23. In this current evaluation, we aim to provide a more general characterisation and included all types of solid organ transplant modalities.…”