We really aren't sure.
We got her at 6 months old, and she came from deplorable conditions. 3 days after bringing her home, she had to have surgery to clear an intestinal blockage ($2.5K!). She also had an issue with her tear ducts that caused a lot of goopiness. At about 2, we allowed her to get pregnant because we wanted some Siamese kittens. At nearly full term, she was having difficulty. Took her back to the vet. One of her kittens had gotten stuck, it died, which lead to the others all being still born by way of an emergency c-section/hysterectomy ($3K!).
She was really, visibly confused and depressed after that for quite a while, as if she knew she was supposed to have babies, but didn't know why there were none. We think this is why she was so eager to instantly start mothering the abandoned litter of kittens we received shortly thereafter.
Anyway, I don't think she was ever truly healthy from the time she was born. I think the environment she was bred in caused her a great deal of disadvantages. Just before she passed, she had a tooth abscess that required yet another emergency procedure that cost a bloody fortune and required her to spend a few nights at the vet. After we brought her home, she never really recovered but seemed relatively OK until suddenly going rapidly downhill in a matter of hours late in the evening. There was nothing we could do but just be with her and love her until she passed at about 3 AM.
It was gut wrenching, I sobbed like a baby. She was such a special kitty, I'm getting choked up typing this out. It was most likely kidney failure according to the vet. We had her cremated and put up a special shelf just for her to perch on with a full view of all of the other cats she helped us save.
I think if we hadn't adopted her, and done so when we did, she wouldn't have lasted beyond that first week, and certainly not for the 6 great years we got to spend with her. I'm glad we were able to make her short life one filled with love and caring. She was a blessing.