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 Nonwood 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-FIT 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-FIT 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.