[Discrepancies between the clinical and pathological diagnosis in lung transplant early mortality].
OBJECTIVE
To analyze the prevalence and frequency spectrum of the most relevant diseases found in the autopsies of patients who underwent a lung transplant and died in the first month after transplantation. To evaluate the consistency of the pre-and post-mortem diagnoses, comparing them with the Goldman et al. scale modified by Battle et al.


METHODS
Retrospective and longitudinal analysis, comparison of the medical records and records of autopsies of patients who received a lung transplant in our center (University Hospital Marques de Valdecilla) from 1997 to 2007, who died in the early postoperative period (first month post-transplant). The discordance between clinical and pathological diagnosis was classified according to the classification of Goldman et al. and Battle et al. The Student t test for quantitative variables and chi-square for qualitative variables were used for the comparison of the groups.


RESULTS
The five class I errors are limited to respiratory diseases: 2 undiagnosed acute rejection, 1 bilateral pulmonary thromboembolism, 1 fat embolism and 1 hemorrhagic infarction of the lung graft. We found a significant difference (p=0.05) between days of survival of patients with group Class I errors (6+/-4.52 days) and patients from the group with no discrepancy (15.42+/-8.99).


CONCLUSIONS
The short time between transplant and death of the patient reduces the possibility of reaching a correct diagnosis. Because of this information, diagnostic possibilities must be maximized in life-threatening diseases during this period. Therefore, the rate of autopsy studies in this period should be 100%.
Castro
A González
AG
Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España. jandro120475@hotmail.com
Llorca
J
J
Fernández-Miret
B
B
Cañas
B Suberviola
BS
Miñambres
E
E
D000208:Acute Disease; D000368:Aged; D001344:Autopsy; D002423:Cause of Death; D004620:Embolism, Fat / Q000175:diagnosis / Q000401:mortality; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000401:mortality; D006470:Hemorrhage / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D007238:Infarction / Q000175:diagnosis / Q000401:mortality; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality*; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000401:mortality; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000401:mortality; D012189:Retrospective Studies; D012769:Shock / Q000175:diagnosis / Q000401:mortality; D013030:Spain / Q000453:epidemiology