POSTMORTEM FINDINGS IN LUNG-TRANSPLANT RECIPIENTS

Lung transplantation is now an accepted modality for treating end-stag e lung disease. To better understand the factors limiting the survival of these patients, we reviewed the autopsy findings in 37 patients wh o received lung transplants. Between 1986 and 1995, 131 patients have undergone lung transplantation at our institution, including 4 patient s with repeat transplantations. Of these, 48 (36.6%) died, 37 (77%) of whom had an autopsy. The autopsied patients were divided into three g roups on the basis of post-transplantation interval: early (< 30 d), i ntermediate (31-365 d), and late (> 365 d). Of the 12 patients in the early group, 6 died of intra- and postoperative complications and 6 of bacterial infection with pneumonia in the transplanted lung. There we re 18 patients in the intermediate group, of whom 11 died of infection (5 of cytomegalovirus, 5 of nonviral infections of the transplanted l ung, and 1 of encephalomyelitis), 3 of post-transplantation lymphoprol iferative disorder, 3 of chronic airway rejection, and one of unrelate d cause. Of the seven patients in the late group, four died of chronic airway rejection, two of unrelated causes, and one of bacterial infec tion. Native lungs examined in 23 patients showed, in addition to the primary disease, bacterial pneumonia in 5, post-transplantation lympho proliferative disorder in 3, cytomegalovirus in 2, and aspergillosis i n 1. In this series of 37 autopsied patients, chronic rejection was th e cause of death in 7 and was concomitantly seen in 3 patients (27%). In summary, the most common cause of death was infection (48%), follow ed by chronic rejection (19%), surgical complications (19%), posttrans plantation lymphoproliferative disorder (7%), and unrelated causes (7% ); rejection was not a major cause of death in the early and intermedi ate post-transplantation periods; in 30% of native lungs, significant pathologic findings were present in addition to the primary disease; a nd in the intermediate post-transplantation period, significant left v entricular hypertrophy occurred, which may be attributable to cyclospo rine-induced hypertension but which needs to be further studied.