Methods: We retrospectively reviewed the medical charts and autopsy records of 131 HCT recipients who underwent autopsy between January 1, 2000 and December 31, 2016. The premortem clinical diagnoses as documented by the clinical teams were compared with autopsy findings. Discrepancies were identified and classified according to the Goldman Criteria (NEJM 1983; 308:1000-5).
Results: A total of 4072 patients received 4395 transplants between January 1, 2000 and December 31, 2016. Of the 1937 patients who died, 131 (7%) had an autopsy performed. Of these 131 patients, 24 (18%) patients had a total of 29 infections that were identified only postmortem; 4 (3%) patients had more than 1 such infection. Of these 29 infections, 15 (52%) were viral, 9 (31%) were fungal, 3 (10%) were bacterial, and 2 (7%) were parasitic; no mycobacterial infections were found. According to the Goldman Criteria, 22 (76%) had class I discrepancies (“major diagnoses for which detection before death would in all probability have led to a change in management that might have resulted in cure or prolonged survival”). Illustrative cases of each infection type will be presented to highlight the challenges of infection management in HCT.
Conclusion: Autopsies of HCT recipients frequently identify clinically significant infections which were not suspected pre-mortem. Our study reinforces the educational value of the autopsy, which is underutilized but can be employed to help prevent future similar infectious complications and improve patient outcomes.
T. Wangjam, None
R. A. Sica, None
D. J. Epstein, None
A. Rezvani, None
D. Ho, None
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