September 1994

Neurologic Complications of Pediatric Heart Transplantation

Author Affiliations

From the Departments of Neurology (Drs Lynch and Glauser), Pediatrics (Dr Canter), and Cardiothoracic Surgery (Dr Spray), St Louis Children's Hospital, Washington University School of Medicine, St Louis, Mo. Dr Glauser is now with the Children's Hospital Medical Center, Cincinnati, Ohio.

Arch Pediatr Adolesc Med. 1994;148(9):973-979. doi:10.1001/archpedi.1994.02170090087016

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.(Arch Pediatr Adolesc Med. 1994;148:973-979)