CAUSES OF DEATH IN RENAL-TRANSPLANT RECIPIENTS - A STUDY OF 102 AUTOPSIES FROM 1968 TO 1991

A study was conducted on 102 patients submitted to renal transplant wh o died and were autopsied at the University Hospital, Faculty of Medic ine of Ribeirao Preto, Brazil, from 1968 to 1991. The cause of death, based an a review of medical records and autopsy reports, was assigned to one of the following categories: infectious (69.6%); cardiovascula r (12.7%); gastrointestinal (7.8%); graft rejection (6.9%); tumoral (2 .0%); and undetermined (1.0%). Among the 71 cases of death caused by i nfection, 28 (39.4%) showed disseminated agents involving two or more organs. Isolated pneumonia involved 17 patients (23.9%), followed by a cute pyelonephritis in the transplanted kidney in 10 patients (14.1%). The most frequent agents were: bacteria (58.0%), divided into 'non-cl assified' (83.0%), Nocardia (10.6%) and Mycobacterium (6.4%); fungi (2 7.5%) represented by Cryptococcus (22.7%), Aspergillus, Candida and Pn eumocystis carinii (18.1% each), Histoplasma (13.6%), Mucor and Paraco ccidioides brasiliensis (4.5% each); viruses (6.2%) represented by Her pes simplex (60.0%); metazoa (5.0%, S. stercoralis), and protozoa (2.5 %, T. cruzi). Cytomegalovirus (CMV) was identified in the lungs of 12 patients and was not directly correlated with death but was associated with other agents. In conclusion, immunodepressed patients such as re nal transplant recipients should be carefully monitored for infection due to the high mortality rate.