CAUSES OF DEATH IN AUTOPSIED LIVER-TRANSPLANTATION PATIENTS

Liver transplantation is an established treatment for multiple end-sta ge liver diseases, yet little information is available on the autopsy- determined causes of death in liver transplant recipients, We undertoo k a retrospective study of the immediate causes of death in all liver transplant recipients who underwent autopsy at the University of Pitts burgh Medical Center, Pittsburgh, Pennsylvania, from January 1982 to J anuary 1997, Infections were the most frequent cause of death, present in 64% of a total of 321 cases, Overall, the infections were bacteria l in 48% of the cases, fungal in 22%, and viral in 12%, The ratio of i nfectious to noninfectious causes of death did not change significantl y during the 15-year study period, and the relative percentages of bac terial, fungal, and viral infections showed relatively little variatio n on a year-to-year basis, Two-thirds of all infections occurred durin g the first 100 days post transplantation. A precipitous drop in the n umber of infections (and the number of deaths) occurred by Day 90, Oth er major causes of death included Liver failure (12%), pulmonary failu re (10%), multiple organ system (8%), and cardiovascular causes (6%). Infections were the most frequent cause of death in this study populat ion, suggesting that improvement in the prevention and treatment of in fections is an important way to improve survival of liver transplant r ecipients.