Neurologic complications of pediatric heart transplantation.

OBJECTIVE

To determine the type and frequency of acquired neurologic complications in survivors of pediatric heart transplantation (HT).

DESIGN

Retrospective study.

SETTING

Tertiary care children's hospital.

PARTICIPANTS

Fourteen survivors of 17 consecutive patients who underwent HT during a 60-month period beginning in January 1986.

INTERVENTIONS: None. MEASUREMENTS OR MAIN

RESULTS

Three distinct subgroups of patients who had undergone HT were identified: six infants with uncorrected hypoplastic left heart syndrome (HLHS), three infants with HLHS who had undergone previous stage 1 Norwood repair, and eight older children with end-stage cardiomyopathy. Fourteen (82%) of 17 children were alive at follow-up. Only one patient (7%) had a significant acquired neurologic deficit (left temporal lobe stroke with subsequent seizures in an infant with uncorrected HLHS). The remaining subjects had normal results of post-HT neurologic examinations (n = 7), minor post-HT neurologic abnormalities (n = 3), no significant change in preexisting neurologic abnormalities (n = 1), or normal neurologic status by report (n = 2). The minor neurologic abnormalities noted post-HT were dysmetria, tremor, and absent reflexes. No episodes of choreoathetosis or cyclosporine-related seizures were seen.

CONCLUSIONS

Pediatric HT is associated with both a high survival rate and a low incidence of severe acquired neurologic deficits despite a significant incidence of severe systemic and metabolic derangements in the pretransplantation and posttransplantation periods. In infants with HLHS, HT seems to carry a lower incidence of severe neurologic morbidity (12%) than other surgical treatments.