Objective: To examine the neuropathologic findings associated with cardiac transplantation and to assess the role, if any, that the neuropathology had in the patient's death.
Design: Retrospective autopsy series of 18 patients.
Setting: Tertiary referral center with a high volume of cardiac transplantation.
Patients: Cardiac transplant patients who died and in whom a complete autopsy was performed.
Results: Eighteen patients, including 11 men and seven women, comprised the study group. Patients ranged in age from 27 to 59 years (mean 48 years). Postoperative survival ranged from 1 to 1517 days (mean 334 days). Autopsies in 15 (83%) patients showed neuropathology; in only one patient, however, was cause of death attributed to these findings. The most common neuropathology was related to anoxia or infarction: ischemia or focal neuronal necrosis (n = 9), diffuse anoxic encephalopathy (n = 3), infarction (n = 6). Other findings included infection with Nocardia, Aspergillus, and Staphylococcus (n = 3) and hemorrhage (n = 3). Of the seven patients who received transplants for ischemic heart disease, five had evidence of cerebral ischemia or infarction. Systemic pathology encountered included infection in 13 patients, ischemia and/or infarction in 11 patients, and hemorrhage in six patients. Cause of death was attributed to infection in nine patients, cardiac rejection in five patients, disseminated intravascular coagulation/hemorrhage in three patients, and systemic amyloidosis in one patient.
Conclusions: The most common neuropathologic findings are related to ischemia and infarction. Neuropathologic findings were only rarely the main cause of death, but they were a significant cause of morbidity in patients who have undergone cardiac allograft transplantation.