Discrepancies between clinical and autopsy diagnosis in liver transplant recipients - A case series

The utility of the autopsy in patients who have undergone prior orthotopic liver transplantation (OLT) has not previously been -defined.- We- sought- to- investigate- the- role- of- the- autopsy- in- liver transplantation by comparing the clinically derived cause of death with the autopsy cause of death in a cohort of liver transplant -recipients- at- our- institution.- This- study- was- undertaken- in- the -setting-of-declining-autopsy-rates-worldwide. Between 2006 and 2011 twenty-nine patients died who had previ- ously undergone OLT, of on whom 19 postmortem examinations were-performed.-We-retrospectively-reviewed-all-post-mortem-find- ings, and separately we examined the corresponding medical -records-to-determine-the-clinical-impression-of-the-cause-of-death. Discrepancies-between-the-post-mortem-and-clinical-findings-were categorised-according-to-a-modification-of-Goldman's-criteria.-Our case series demonstrated a discrepancy between the clinical and post-mortem-examination-(PME)-findings-in-54%-of-patients.-Two patients-had-major-diagnoses-(Goldman-Class-1)-not-detected-clini- cally and in seven patients the PME revealed additional undetected minor- diagnoses.- This- case- series- demonstrates- that,- even- in- the modern era of advanced diagnostic imaging techniques, the post mortem-examination-continues-to-be-a-valuable-tool-in-confirming diagnostic accuracy and improving standards in the care of liver transplant-recipients.-(Acta gastroenterol. belg., 2013, 76, 429-432).