[Early fatal lesions after cardiac transplantation. Results of 100 autopsies].
The results of 100 consecutive autopsy studies performed since the introduction and use of cyclosporine (1984 to 1991) in patients who died less than 2.5 months after cardiac transplantation were analysed to try to prevent this type of lethal damage. The lesions were complex but the causes of death may be classified as follows: 44 infections (20 aspergillosis, with 13 septicaemias and 7 predominantly pulmonary complications, 15 severe lung infections, 9 other infections including 7 pyogenic mediastino-pericarditis), 12 acute myocardial rejects, 14 pulmonary arteriolitis reflecting the fact that pulmonary resistances affect the results of cardiac transplantation, 13 non-infectious pericarditis, 17 immediate postoperative deaths (incompetent graft, DIVC). In the discussion, the authors underline the importance of pericardial damage, the direct cause of death in 13 cases but also present in most cases of infection when sometimes clinically confused with the diagnosis of "acute reject". Acute pancreatitis (over 10% of cases) were often labelled "septicaemic shock". Pulmonary involvement is one of the commonest complications related to infection and changes due to passive pulmonary hypertension related to the causal preoperative disease, by silent pulmonary embolism during the 3 months of cardiac failure before surgery and DIVC. Infection was the cause of death in nearly half of the early fatalities, and aspergillosis was particularly common whereas systematic prevention with sulfadoxine-pyrimethamine has eliminated pneumocystosis for example. The management of immuno-depression varies from centre to centre and this is also a factor in the incidence of anatomical complications.(ABSTRACT TRUNCATED AT 250 WORDS)
Loire
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Hôpital cardiopneumologique, Lyon.
Tabib
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D001228:Aspergillosis / Q000209:etiology / Q000401:mortality; D006086:Graft vs Host Disease; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007239:Infections / Q000209:etiology* / Q000382:microbiology; D008168:Lung / Q000473:pathology; D009206:Myocardium / Q000473:pathology; D010490:Pericardial Effusion / Q000209:etiology; D010494:Pericarditis, Constrictive / Q000209:etiology; D012141:Respiratory Tract Infections / Q000209:etiology / Q000401:mortality
Lésions mortelles précoces après transplantation cardiaque. Résultats de 100 autopsies.