CAUSES OF DEATH AFTER LIVER-TRANSPLANTATI ON - AN ANALYSIS OF 41 CASES IN 382 PATIENTS

Summ. The aim of this study was to analyse the causes of death after l iver transplantation in order to find and to avoid preventable fatal c omplications if possible. Methods: Between September 1988 and Septembe r 1993 415 orthotopic liver transplantations in 382 patients were perf ormed at the Rudolf Virchow University Hospital in Berlin. During the same interval 41 (10,7%) of these patients died. Their clinical record s were reviewed. Results: The main cause of death was infection (29,3% ), followed by recurrent malignancy (21,9%). Less patients died besaus e of hepatitis B - reinfection (14,6%), chronic rejection (7,3%), hemo rrhage (7,3%), cardiac failure (7,3%), trauma (4,8%), hypoxia (4,8%) a nd recurrence of alcoholic liver disease (4,8%). There was a wide spec trum of opportunistic infectious agents with CMV and Pneumocystis cari nii being the most important pathogenic organisms. Only one isolated b acterial infection as principle cause of death was found. In all fatal infections the lung was the primary site of infection, 7 patients add itionally developed sepsis. Altogether 75 patients (19,6%) with hepati tis B - cirrhosis were transplanted. Six of them (8%) developed a fata l hepatitis B - reinfection. Malignancy was the indication for OLT in 41 patients (10,7%). Six of these patients (14,6%) died because of rec urrent tumor. Regarding the whole series, most deaths occurred four to twelve months (58,5%) and only five (12,2%) during the first month af ter OLT. Conclusion: Recurrence of primary disease is an important fac tor regarding total mortality. Therefore it is necessary to practise a careful selection of liver transplant recipients. In the future more attention needs to be drawn towards prevention, identification and man agement of opportunistic infections.