The neuropathology of cardiac allograft transplantation. An autopsy series of 18 patients.
OBJECTIVE
To examine the neuropathologic findings associated with cardiac transplantation and to assess the role, if any, that the neuropathology had in the patient's death.


METHODS
Retrospective autopsy series of 18 patients.


METHODS
Tertiary referral center with a high volume of cardiac transplantation.


METHODS
Cardiac transplant patients who died and in whom a complete autopsy was performed.


RESULTS
Eighteen patients, including 11 men and seven women, comprised the study group. Patients ranged in age from 27 to 59 years (mean 48 years). Postoperative survival ranged from 1 to 1517 days (mean 334 days). Autopsies in 15 (83%) patients showed neuropathology; in only one patient, however, was cause of death attributed to these findings. The most common neuropathology was related to anoxia or infarction: ischemia or focal neuronal necrosis (n = 9), diffuse anoxic encephalopathy (n = 3), infarction (n = 6). Other findings included infection with Nocardia, Aspergillus, and Staphylococcus (n = 3) and hemorrhage (n = 3). Of the seven patients who received transplants for ischemic heart disease, five had evidence of cerebral ischemia or infarction. Systemic pathology encountered included infection in 13 patients, ischemia and/or infarction in 11 patients, and hemorrhage in six patients. Cause of death was attributed to infection in nine patients, cardiac rejection in five patients, disseminated intravascular coagulation/hemorrhage in three patients, and systemic amyloidosis in one patient.


CONCLUSIONS
The most common neuropathologic findings are related to ischemia and infarction. Neuropathologic findings were only rarely the main cause of death, but they were a significant cause of morbidity in patients who have undergone cardiac allograft transplantation.
Prayson
R A
RA
Department of Anatomic Pathology, Cleveland Clinic Foundation, OH 44195.
Estes
M L
ML
D000328:Adult; D001344:Autopsy; D001922:Brain Abscess / Q000473:pathology; D002423:Cause of Death; D002544:Cerebral Infarction / Q000473:pathology; D005260:Female; D006331:Heart Diseases / Q000473:pathology*; D016027:Heart Transplantation / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology; D017202:Myocardial Ischemia / Q000473:pathology; D012189:Retrospective Studies