Neuropathology of heart transplantation: 23 cases

We reviewed the clinical histories, operative results, and neuropathologic findings of 23 consecutive patients who had heart transplants. Prolonged preoperative hypotension and failure of cerebral autoregulation of blood flow, followed by postoperative elevation of blood pressure beyond the limits of cerebral autoregulation, may account for the high incidence of neurologic complications (70%); 60% were vascular. Immunosuppressive therapy may have been responsible for the high incidence (20%) of opportunistic intracranial infections. Lymphoproliferative disorders occurred in three patients (13%).