Study of Necropsies of Patients Submitted to Heart Transplantation: NEHTS-NecropsyHeartTransplantationStudy

Abstract

Purpose: Autopsy has been considered the gold standard for diagnosing the cause of death. Discrepancies between pre and post-mortem diagnosis continue to be reported, ranging from 4.1 to 49.8% of cases referred for autopsy examination. Methods and Materials: Retrospective study. It was included all autopsies of heart transplanted patients performed between 2000-2010. Clinical data of patients, medical cause of death and cause of death at autopsy were analyzed. Then pre-mortem diagnosis was confronted with the cause ofdeath at necropsy according to the criteria of Goldman et al. (N Engl J Med 1983;308:1000.) Results: 48 autopsies were analyzed; 29 (60.4%) had a nondiscrepant diagnosis, 16 (33.3%) had a discrepant diagnosis and 3 (6.3%) had uncertain autopsy diagnosis. Among the discrepant diagnosis, 15 (31.3%) had possible impact on survival and 1 (2.1%) had no impact on survival. Among those pre-morten diagnoses associated with discrepancies, infection (31.3%) heads the list, followed by hyperacute rejection (18.8%), pulmonary thromboembolism (18.8%) and acute cellular rejection (18.8%). Conclusions: Even with advances in diagnostic technology, there are still differences between the clinical diagnosis and post-mortem findings. Furthermore, in most cases an accurate clinical diagnosis could led to a change in therapy and prolonged survival.