Cause of Death and Sudden Cardiac Death After Heart Transplant
Cause of Death and Sudden Cardiac Death After Heart Transplant
Postmortem findings in 39 patients following cardiac transplantation are presented. Causes of death were right-sided heart failure after transplantation (6 [15%]), infection (5 [13%]), multisystem organ failure (4 [10%]), complications of noncardiac surgery (3 [8%]), acute rejection (3 [8%]), malignant neoplasm (3 [8%]), graft vascular disease (3 [8%]), preservation procurement injury (3 [8%]), cardiac arrhythmia (2 [5%]), other (4 [10%]), and unclear (3 [8%]). Seven patients in medically stable condition died after a sudden cardiac arrest, and these constituted 27% (7/26) of deaths more than 1 month after transplant. The 7 sudden cardiac arrests were due to graft vascular disease (2 [29%]), acute rejection (2 [29%]), cardiac arrhythmias (2 [29%]), and hyperkalemia during an exacerbation of acute renal failure (1 [14%]). In 3 of the 5 patients who died of sudden cardiac arrest not due to acute rejection, hemodialysis and plasmapheresis were triggers of the event. Pulmonary hypertensive arteriopathy was associated with early death and right-sided heart failure, and 6 of 8 patients with these changes died perioperatively or postoperatively.
Orthotopic heart transplantation is a well-established procedure to prolong the life of patients with severe cardiomyopathy due to a variety of causes. More than 57,000 heart transplants had been reported to the Registry of the International Society for Heart and Lung Transplantation through the year 2000. Although substantial data have been reported as to the cause of death in these patients, most autopsy-based studies are at least a decade old. Few new autopsy data have been presented since McManus highlighted the pressing need for these types of studies to better understand allograft pathology, transplant arteriopathy, and the spectrum of disease present in heart transplant recipients. We reviewed the autopsy reports and clinical records of cardiac transplant recipients during a 16-year interval to determine the cause of death. A subgroup of patients who died of sudden cardiac arrest is discussed in detail.
Postmortem findings in 39 patients following cardiac transplantation are presented. Causes of death were right-sided heart failure after transplantation (6 [15%]), infection (5 [13%]), multisystem organ failure (4 [10%]), complications of noncardiac surgery (3 [8%]), acute rejection (3 [8%]), malignant neoplasm (3 [8%]), graft vascular disease (3 [8%]), preservation procurement injury (3 [8%]), cardiac arrhythmia (2 [5%]), other (4 [10%]), and unclear (3 [8%]). Seven patients in medically stable condition died after a sudden cardiac arrest, and these constituted 27% (7/26) of deaths more than 1 month after transplant. The 7 sudden cardiac arrests were due to graft vascular disease (2 [29%]), acute rejection (2 [29%]), cardiac arrhythmias (2 [29%]), and hyperkalemia during an exacerbation of acute renal failure (1 [14%]). In 3 of the 5 patients who died of sudden cardiac arrest not due to acute rejection, hemodialysis and plasmapheresis were triggers of the event. Pulmonary hypertensive arteriopathy was associated with early death and right-sided heart failure, and 6 of 8 patients with these changes died perioperatively or postoperatively.
Orthotopic heart transplantation is a well-established procedure to prolong the life of patients with severe cardiomyopathy due to a variety of causes. More than 57,000 heart transplants had been reported to the Registry of the International Society for Heart and Lung Transplantation through the year 2000. Although substantial data have been reported as to the cause of death in these patients, most autopsy-based studies are at least a decade old. Few new autopsy data have been presented since McManus highlighted the pressing need for these types of studies to better understand allograft pathology, transplant arteriopathy, and the spectrum of disease present in heart transplant recipients. We reviewed the autopsy reports and clinical records of cardiac transplant recipients during a 16-year interval to determine the cause of death. A subgroup of patients who died of sudden cardiac arrest is discussed in detail.
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