Cause of death and sudden cardiac death after heart transplantation: An autopsy study

Russell T. Alexander, Charles Steenbergen

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Postmortem findings in 39 patients following cardiac transplantation are presented. Causes of death were right-sided heart failure after transplantation (6 [15%]), infection (5 [13%]), multisystem organ failure (4 [10%]), complications of noncardiac surgery (3 [8%]), acute rejection (3 [8%]), malignant neoplasm (3 [8%]), graft vascular disease (3 [8%]), preservation procurement injury (3 [8%]), cardiac arrhythmia (2 [5%]), other (4 [10%]), and unclear (3 [8%]). Seven patients in medically stable condition died after a sudden cardiac arrest, and these constituted 27% (7/26) of deaths more than 1 month after transplant. The 7 sudden cardiac arrests were due to graft vascular disease (2 [29%]), acute rejection (2 [29%]), cardiac arrhythmias (2 [29%]), and hyperkalemia during an exacerbation of acute renal failure (1 [14%]). In 3 of the 5 patients who died of sudden cardiac arrest not due to acute rejection, hemodialysis and plasmapheresis were triggers of the event. Pulmonary hypertensive arteriopathy was associated with early death and right-sided heart failure, and 6 of 8 patients with these changes died perioperatively or postoperatively.

Original languageEnglish (US)
Pages (from-to)740-748
Number of pages9
JournalAmerican journal of clinical pathology
Issue number5
StatePublished - May 1 2003
Externally publishedYes


  • Autopsy
  • Cardiac transplantation
  • Coronary atherosclerosis
  • Fibrointimal hyperplasia
  • Rejection

ASJC Scopus subject areas

  • Pathology and Forensic Medicine


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