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[Early central neurologic complications after heart transplantation are associated with higher intra-hospital
Pedro E Colla Machado1, Agustín Pappolla1, Natalia R Balian1
1Servicio de Neurología, Hospital Italiano de Buenos Aires, Argentina.
Insights
Neurological complications after heart transplantation significantly increase in-hospital mortality. Early central nervous system issues, like encephalopathy, are linked to worse outcomes for transplant recipients.
Area of Science:
- Cardiology
- Neurology
- Transplantation Medicine
Background:
- Neurological complications are a significant challenge in heart transplantation, impacting patient morbidity and mortality.
- Despite successful organ engraftment, neurological issues can severely affect patient outcomes post-transplant.
Purpose of the Study:
- To investigate the incidence and impact of neurological complications on patient outcomes following orthotopic heart transplantation.
- To identify specific neurological complications and their association with in-hospital mortality in heart transplant recipients.
Main Methods:
- Retrospective analysis of 193 adult patients undergoing heart transplantation between November 2014 and August 2018.
- Evaluation of demographic and clinical variables, focusing on the occurrence of central and peripheral neurological complications within the first week post-transplant.
- Comparison of outcomes, including hospital mortality, between patients with and without neurological complications.
Main Results:
- Central neurological complications occurred in 12% of patients within the first week post-transplant, with encephalopathy being the most frequent (5%).
- Peripheral neuropathy was observed in 4% of cases.
- Patients experiencing central neurological complications exhibited significantly higher in-hospital mortality (32%) compared to those without (9%, p = 0.002).
Conclusions:
- Central neurological complications are associated with a substantially increased risk of in-hospital mortality after heart transplantation.
- Early identification and management of neurological complications are crucial for improving outcomes in heart transplant recipients.
Abstract:
Neurological complications in orthotopic heart transplantation represent a major cause of morbidity and mortality despite successful transplantation. The aim of our study was to evaluate neurological complications on the outcome of patients with heart transplantation. We retrospectively studied 193 adult patients (aged = 18 years) who underwent heart transplant at Hospital Italiano in Buenos Aires from November 2014 to August 2018. We evaluated demographic and clinical vari ables and outcome of patients with and without neurological complications. We included 193 patients with a mean age of 51 ± 12 years of which 74% (n = 143) were men. The two most frequent causes that led to heart transplantation were idiopathic cardiomyopathy in 34% (n = 65) and ischemic cardiomyopathy in 29% (n = 56). Hemodynamic instability was present at the moment of transplant in 92% (n = 176) of the cases. Central neurological complications in the first week post-transplant occurred in 12% (n = 23). The most frequent were: encephalopathy (5%), subdural hematoma (2%), subarachnoid hemorrhage (2%), seizures (2%) and ischemic stroke (1%). Peripheral neuropathy was observed in 4% of cases. Hospital mortality was 11% (n = 22) and 88% (n = 170) was discharged at home. Those who presented central neurological complications had higher in-hospital mortality compared to those who did not (32% vs. 9%, p = 0.002).
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