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Neurologic Complications After Pediatric Heart Transplant: A Single-Center Experience
Ali Orgun1, Ilkay Erdogan, Birgül Varan
1From the Department of Pediatric Cardiology, Baskent University Faculty of Medicine, Ankara, Turkey.
Insights
Neurologic complications affect 27% of pediatric heart transplant recipients, with posterior reversible encephalopathy syndrome and stroke being common causes. Early detection and treatment are crucial for better outcomes in these young patients.
Area of Science:
- Pediatric Cardiology
- Neurology
- Transplantation Medicine
Background:
- Neurologic complications are a significant concern in pediatric heart transplant recipients, with reported rates ranging from 23.6% to 45%.
- These complications can lead to serious mortality and morbidity.
- Understanding the frequency, timing, causes, and characteristics is vital for improving patient care.
Purpose of the Study:
- To evaluate the frequency, time of onset, causes, and clinical characteristics of neurologic complications in pediatric heart transplant recipients.
- To compare clinical features between pediatric heart transplant patients with and without neurologic complications.
Main Methods:
- A retrospective review of data from 37 pediatric heart transplant recipients (age <18 years) between 2007 and 2017.
- Identification of neurologic complications through medical record review.
- Comparison of clinical features between patients with and without neurologic complications.
Main Results:
- The rate of posttransplant neurologic complications was 27% (10/37).
- Common etiologies included posterior reversible encephalopathy syndrome (8.1%), stroke (5.4%), and peripheral neuropathy (5.4%).
- No significant differences in clinical features were observed between recipients with and without neurologic complications (P > .05).
Conclusions:
- Neurologic complications are frequent in pediatric heart transplant recipients and can lead to significant adverse outcomes.
- Early detection and prompt treatment of neurologic findings are essential to reduce sequelae.
- This study provides a detailed single-center experience of neurologic complications in this vulnerable population.
Objectives:
Neurologic complications that can lead to serious mortality and morbidity in pediatric heart transplant recipients have been reported to range from 23.6% to 45%. In this study, the frequency, time, cause, and characteristics of neurologic complications in pediatric heart transplant recipients were evaluated.
Materials And Methods:
We retrospectively reviewed data of 37 pediatric heart transplant recipients aged <18 years who were seen at our hospital between 2007 and 2017. Medical records were reviewed to identify neurologic complications. Clinical features were compared between pediatric heart transplant patients with and without neurologic complications.
Results:
The rate of posttransplant neurologic complications in pediatric heart transplant was 27% (10/37). Median age of patients with neurologic complications was 12 years (range, 11-18 years). Median time for neurologic complications was 3 days (range, 2-46 days). Primary diagnoses of these 10 recipients were dilated cardiomyopathy (n = 7) and restrictive cardiomyopathy (n = 3). There were no significant differences between recipients with and without neurologic complications (P > .05).The etiologies of neurologic complications were posterior reversible encephalopathy syndrome in 3 patients (8.1%), stroke in 2 patients (5.4%), peripheral neuropathy in 2 patients (5.4%), hypertensive encephalopathy in 1 patient (2.7%), and drug encephalopathy in 1 patient (2.7%).
Conclusions:
Neurologic complications may lead to serious mortality and morbidity in pediatric heart transplant patients. Seizures, posterior reversible encephalopathy syndrome, stroke, peripheral neuropathy, transient ischemic attack, and cerebral infections are the most common neurologic complications, which are seen in the perioperative period in particular. Careful follow-up of pediatric heart transplant patients, with detection and early treatment of neurologic findings, will contribute to lower rates of sequelae. To our knowledge, this is the largest study to show a detailed experience of neurologic complications in pediatric heart transplant patients from a single center in Turkey.
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