title: Discrepancies between clinical and autopsy diagnosis in liver transplant recipients - a case series.
abstract: The utility of the autopsy in patients who have undergone prior orthotopic liver transplantation (OLT) has not previously been defined. We sought to investigate the role of the autopsy in liver transplantation by comparing the clinically derived cause of death with the autopsy cause of death in a cohort of liver transplant recipients at our institution. This study was undertaken in the setting of declining autopsy rates worldwide. Between 2006 and 2011 twenty-nine patients died who had previously undergone OLT, of on whom 19 postmortem examinations were performed. We retrospectively reviewed all post mortem findings, and separately we examined the corresponding medical records to determine the clinical impression of the cause of death. Discrepancies between the post mortem and clinical findings were categorised according to a modification of Goldman's criteria. Our case series demonstrated a discrepancy between the clinical and post mortem examination (PME) findings in 54% of patients. Two patients had major diagnoses (Goldman Class 1) not detected clinically and in seven patients the PME revealed additional undetected minor diagnoses. This case series demonstrates that, even in the modern era of advanced diagnostic imaging techniques, the post mortem examination continues to be a valuable tool in confirming diagnostic accuracy and improving standards in the care of liver transplant recipients.
authors.affiliation: Department of Anaesthesia and Intensive Care, St Vincent's University Hospital, Dublin 4, Ireland. frohlics@yahoo.co.uk
authors.forename: Stephen
authors.initials: S
authors.lastname: Fröhlich
authors.affiliation: Department of Anaesthesia and Pain Management, Wellington Regional Hospital, Newton, Wellington, New Zealand.
authors.forename: Orla
authors.initials: O
authors.lastname: Ryan
authors.affiliation: Department of Anaesthesia and Intensive Care, St Vincent's University Hospital, Dublin 4, Ireland.
authors.forename: Noelle
authors.initials: N
authors.lastname: Murphy
authors.affiliation: School of Medicine, University College Dublin.
authors.forename: Nuala
authors.initials: N
authors.lastname: McCauley
authors.affiliation: Department of Pathology, St Vincent's University Hospital, Dublin 4, Ireland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Crotty
authors.affiliation: Department of Anaesthesia and Intensive Care, St Vincent's University Hospital, Dublin 4, Ireland.
authors.forename: Donal
authors.initials: D
authors.lastname: Ryan
mesh_terms: D000328:Adult; D000368:Aged; D001344:Autopsy; D002423:Cause of Death / Q000639:trends; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008099:Liver / Q000473:pathology*; D017114:Liver Failure, Acute / Q000401:mortality / Q000473:pathology*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000473:pathology*; D012189:Retrospective Studies