Okada Masanao, Kyakuno Miyaji, Imamura Junichi, Nakamura Takayuki, Takahara Shiro
Department of Pathology, Osaka Seamen's Insurance Hospital, Osaka, Japan.
Clin Transplant. 2002;16 Suppl 8:58-61. doi: 10.1034/j.1399-0012.16.s8.3.x.
Few autopsy cases of sudden death in renal transplant recipients have been reported in the literature. The present case was a 50-year-old female recipient of a living-related renal transplant, who died suddenly after a good post-transplant course of 14 years. The patient was admitted in December 2000 for detailed investigation for ascites, and died unexpectedly 1 month later. She complained of mild dyspnoea approximately 3 h before death. Detailed clinical and laboratory investigations after admission showed no malignant findings in the abdominal cavity. Postmortem pathological examination also showed no tumour in the abdominal cavity. Both lungs were pneumatized. Histopathological examinations revealed metastatic calcification. Calcification was observed in the heart, lungs, kidney graft and pancreas. Calcification in the heart was found in the central fibrous body surrounding the atrioventricular node and bundle of His, as well as in the origin of bifurcating bundle. In the myocardial fibres, fibre rupture and waviness were observed. Although these findings may indicate agonal changes, they might also be a consequence of sudden cardiac death. This patient was in a state of renal failure, which presumably caused metastatic calcification involving also the cardiac conduction system. This calcification might partially account for the sudden death.
文献中报道的肾移植受者猝死的尸检病例很少。本病例是一名50岁的活体亲属肾移植女性受者，在移植后14年的良好病程后突然死亡。患者于2000年12月因腹水进行详细检查入院，1个月后意外死亡。她在死亡前约3小时诉说轻度呼吸困难。入院后详细的临床和实验室检查未发现腹腔内有恶性病变。尸检病理检查也未发现腹腔内有肿瘤。双肺均已充气。组织病理学检查显示有转移性钙化。在心脏、肺、肾移植和胰腺中均观察到钙化。心脏中的钙化见于房室结和希氏束周围的中央纤维体以及分支束的起始处。在心肌纤维中，观察到纤维断裂和波浪状改变。虽然这些发现可能表明濒死改变，但它们也可能是心源性猝死的结果。该患者处于肾衰竭状态，这可能导致了包括心脏传导系统在内的转移性钙化。这种钙化可能部分解释了猝死的原因。
