1573. Discrepancies Between Premortem and Postmortem Diagnoses of Infectious Diseases Found on Autopsy in Hematopoietic Cell Transplantation Recipients at a High-volume Academic Transplant Center
Session: Poster Abstract Session: Viruses and Bacteria in Immunocompromised Patients
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • 2018-09-21 Ashrit Multani IDWeek Poster.pdf (2.8 MB)
  • Background: Hematopoietic cell transplantation (HCT) is a potentially curative treatment option for patients with hematologic malignancies and other diseases but carries a significant risk of infection-related morbidity and mortality. Many of these infections are difficult to diagnose and treat. It is not infrequent that HCT recipients die from infection despite extensive investigations and broad-spectrum antimicrobial therapy. Autopsy is the gold standard for establishing the cause of death but rates of performing autopsies are decreasing despite their immense value. We present the most recent case series of infectious diseases found on autopsy in HCT recipients at our high-volume academic transplant center.

    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.

    Ashrit Multani, MD1, Libby Allard, MD2, Tamna Wangjam, MD3, R. Alejandro Sica, MD3, David J. Epstein, MD1, Andrew Rezvani, MD3 and Dora Ho, MD, PhD1, (1)Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, (2)Department of Pathology, Stanford University School of Medicine, Stanford, CA, (3)Department of Medicine, Division of Blood and Marrow Transplantation, Stanford University School of Medicine, Stanford, CA

    Disclosures:

    A. Multani, None

    L. Allard, None

    T. Wangjam, None

    R. A. Sica, None

    D. J. Epstein, None

    A. Rezvani, None

    D. Ho, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.