Autopsy-determined causes of death following cardiac transplantation. A study of 81 patients and literature review.

Abstract

The principal and contributory causes of death in 81 autopsied heart transplant patients who died at Groote Schuur Hospital, Cape Town, South Africa, were investigated and subdivided according to the immunosuppressive regimen used as well as the postoperative survival period. Mean graft survival was 488 days. Chronic rejection (30%), infection (23%), and acute rejection (20%) were the most common principal causes of death. Both fatal and nonfatal infections involved the lung predominantly. A review of the literature revealed 198 other autopsied heart transplant patients whose principal cause of death could be analyzed; infection accounted for almost half of these latter deaths, followed by acute and chronic rejection. Contributory causes of death in the 81 patients were as follows: infection (17%), acute rejection (16%), chronic rejection (14%), miscellaneous conditions (14%), embolism (14%), pancreatitis (11%), peptic ulcer (9%), inadequate donor heart (3%), and malignancy (1%). We conclude that infection, together with acute and/or chronic rejection, are still the major causes of death in heart transplant patients.