Pulmonary Complications After Solid Organ Transplantation: An Autopsy Perspective.

Pulmonary complications following solid organ transplantation are common and often infectious in nature. Articles describing noninfectious pulmonary complications overwhelmingly rely on clinical and radiographic data. There are a limited number of studies with companion histology delineating the clinical diagnoses of pulmonary complications. This contrasts with blood and bone marrow transplantations. Using a retrospective cohort approach, the current study aimed to assess antemortem and postmortem pulmonary findings in solid organ transplantation recipients. Medical records and autopsy materials from 92 solid organ transplantation recipients were reviewed. Pulmonary complications were identified in 70 patients (76%). For patients with pulmonary complications at autopsy the mean survival posttransplantation was 3.48 years as compared to 7.29 years for patients without pulmonary complications at autopsy (P = .01). Twenty-eight infectious complications (fungal pneumonia, n = 20; cytomegalovirus pneumonia, n = 7; bacterial pneumonia, n = 1) and 113 noninfectious pulmonary complications were identified. The most common noninfectious findings were diffuse alveolar damage (n = 32), organizing pneumonia (n = 31), and pulmonary thromboemboli (n = 26). Disseminated infections and respiratory failure were the most common immediate causes of death (n = 24 and n = 23, respectively). Most noninfectious complications were not diagnosed antemortem.

The relevance of tissue thiol histochemistry to diagnostic hematopathology.

Expression analyses suggest that alterations of the antioxidant state of some diffuse large B-cell lymphomas can assist prognosis; reversibly oxidized thiols may serve as a surrogate marker for identifying such cases. Little is known about the distribution of free thiols and reversibly oxidized thiols in human tissues. We developed a staining technique that enables visualization of tissue thiols in situ using bright field microscopy and validated it using gastrointestinal tissue specimens. We used our thiol staining technique to assess benign tonsillectomy and diffuse large B-cell lymphoma specimens. The gastrointestinal series revealed the presence of free thiols within epithelial cells and cells of the lamina propria. Staining for reversibly oxidized thiols was robust in gastric foveolar cells, intestinal goblet cells and the mucus they produce. Tonsillectomy specimens exhibited diffuse presence of free thiols. Staining for reversibly oxidized thiols was confined to germinal center macrophages and sinus histiocytes. Among the diffuse large B-cell lymphoma specimens, we observed strong staining for free thiols within malignant cells. By contrast to benign B-cells, the malignant cells demonstrated pronounced and diffuse staining for reversibly oxidized thiols. We demonstrated intrinsic differences between benign and malignant cells.