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Neurologic complications of heart transplantation in children
A B Martin1, J T Bricker, M Fishman
1Texas Children's Hospital, Houston 77030.
Insights
Neurologic complications after pediatric heart transplants are common but rarely lead to long-term disability. Improved management strategies have significantly reduced their occurrence and severity in survivors.
Area of Science:
- Pediatric Cardiology
- Pediatric Neurology
- Transplantation Medicine
Background:
- Neurologic complications are a significant concern following pediatric orthotopic heart transplantation.
- These complications can occur in up to 50% of pediatric heart transplant recipients.
- Identifying the prevalence and outcomes of these complications is crucial for improving patient care.
Purpose of the Study:
- To determine the prevalence and outcomes of neurologic complications in children undergoing heart transplantation.
- To compare neurologic complication rates between different periods of the study.
Main Methods:
- Retrospective review of pediatric patients (n=22) who underwent orthotopic heart transplantation between November 1984 and November 1990.
- Comparison of neurologic complication rates between two time periods: 1984-1987 (group 1) and 1987-1990 (group 2).
- Definition of neurologic complication as any change in neurologic examination or status.
Main Results:
- Overall survival improved from 45% in group 1 to 73% in group 2.
- Neurologic complications occurred in 45% of patients early post-operation and 23% late post-operation.
- The incidence of any neurologic complication (early or late) significantly decreased from group 1 (100%) to group 2 (64%, p < 0.015).
- Serious neurologic morbidity decreased with avoidance of preoperative cyclosporine and control of postoperative hypertension.
- All survivors are functioning at age-appropriate levels, with rare long-term neurologic disability.
Conclusions:
- Neurologic complications are frequent following pediatric heart transplantation but are often transient.
- Improvements in management, including avoiding preoperative cyclosporine and controlling hypertension, have reduced neurologic morbidity.
- Long-term neurologic disability is rare in survivors of pediatric heart transplantation.
Abstract:
Neurologic complications can add significant morbidity to otherwise successful orthotopic heart transplantations in children. Complications have been reported to occur in up to 50% of children undergoing heart transplantation. The purpose of this study was to identify the prevalence and outcome of neurologic complications of heart transplantation in children. We reviewed all children who received orthotopic heart transplantation at Texas Children's Hospital from November 1984 to November 1990. Twenty-two patients (ages, 3 weeks to 17 years; mean, 8.5 years) underwent heart transplantation using cardiopulmonary bypass with moderate hypothermia. For analysis, we compared results during the first 3 years of our experience, 1984 through 1987 (group 1), to 1987 through 1990 (group 2). Survival was 45% (5 of 11 patients) for group 1 and 73% (8 of 11 patients) for group 2. A neurologic complication was defined as a change in the neurologic examination and/or status. Neurologic complications included seizures (6 of 22 patients), strokes (3 of 22 patients), unresponsiveness (3 of 22 patients), and change in mental status (2 of 22 patients). Early (within 2 weeks after operation) neurologic complications occurred in 45% (10 of 22 patients), were persistent (sequelae lasting more than 4 months) in 27% (6 of 22 patients), and resulted in death in 9% (2 of 22 patients). Late (after 2 weeks after operation) neurologic complications occurred in 23% (5 of 22 patients), were persistent in 9% (2 of 22 patients), and have occurred in only two survivors. Neurologic factors were not responsible for the cause of death in group 2. No neurologic complications (early or late) were seen in 1 of 11 patients in group 1 as compared with 7 of 11 patients in group 2 (p < 0.015). Serious neurologic morbidity decreased between the two groups after preoperative cyclosporine was avoided and postoperative hypertension was controlled. All survivors are functioning at age-appropriate levels. Although neurologic complications may be frequent, long-term neurologic disability in survivors is rare.