Medicolegal reflections about a case of cardiac death after renal transplantation.
Cardiovascular disease is the most common cause of death in patients with renal transplant. Acute coronary syndrome due to coronary artery disease, and left ventricular hypertrophy leading to chronic heart failure account for the majority of sudden arrhythmic deaths after transplantation. Furthermore death with functioning graft represents the main cause of graft loss, particularly after the first post-transplantation year. Although cardiovascular disease leads to morbidity and mortality in renal transplant recipients, its pathogenesis is poorly understood. The high incidence of cardiovascular disease in patients after renal transplant is chiefly due to high occurrence and accumulation of traditional risk factors before and after transplantation. Hypertension, post-transplant diabetes mellitus and hyperlipidemia increase the risk for cardiovascular events. Also 'non traditional' risk factors are associated with cardiovascular disease. Moreover several immunosuppressive drugs interfere with the cardiovascular system. The authors present a case of cardiac death following renal transplant in a patient with history of cardiovascular disease prior transplantation. Initially treated by hemodialysis, after 3 years he received a cadaveric renal transplant. The post-transplantation period was without surgery complications, immunological or infectious, except for a scarce control of blood pressure. A month after the operation, the patient developed thrombophlebitis, plus extra-peritoneal swelling. After ten days in hospital he suddenly died. The aim of the manuscript is to remark on the legal relevance of patient's consensus to transplant. It is necessary to well inform patients of an operation's risks and complications. Furthermore, the exceeding demand with respect to organ availability raises ethical issues about organ allocation.
Institute of Legal Medicine, University of Pisa, S Chiara Hospital, Pisa, Italy. marcodipaolo@med.unipi.it
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D002318:Cardiovascular Diseases / Q000150:complications* / Q000473:pathology; D017809:Fatal Outcome; D006084:Graft Rejection; D006406:Hematoma / Q000473:pathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D032383:Myocytes, Cardiac / Q000473:pathology; D009395:Nephritis, Interstitial / Q000150:complications / Q000601:surgery; D010537:Peritoneum; D011183:Postoperative Complications; D011654:Pulmonary Edema / Q000473:pathology; D013924:Thrombophlebitis / Q000209:etiology