title: Cyclosporine may affect improvement of cognitive brain function after successful cardiac transplantation.
abstract: BACKGROUND
  The effects of cardiac transplantation on cognitive brain function are uncertain.
  
  
  RESULTS
  We measured cognitive brain function and quality of life in out-of-hospital cardiac transplant candidates (n = 55; ejection fraction, 19.9%; age, 54.8 years [means]). After transplantation, the patients were serially reevaluated at 4 months (n = 25) and at 12 months (n = 19). Brain function was measured objectively by cognitive P300 evoked potentials. Additionally, standard psychometric tests (Trail Making Test A, Mini-Mental State Examination, and Profile of Mood State test) were performed. Cognitive P300 evoked potentials were impaired in cardiac transplant candidates (359 ms, recorded at vertex) compared with 55 age- and sex-matched healthy subjects (345 ms, P < .01). Trail Making Test A was also abnormal (45 versus 31 seconds in 55 healthy subjects, P < .01). After transplantation, P300 measures were normalized at 4 months (345 ms, P < .05 versus before transplantation) but declined again at 12 months (352 ms, P = NS versus before transplantation). Stepwise multiple regression analysis revealed that cumulative cyclosporine dosage was the only predictor of individual cognitive brain function 4 months (753 mg/kg body wt, P < .05) and 12 months (2006 mg/kg body wt, P < .01) after transplantation, respectively.
  
  
  CONCLUSIONS
  Objective cognitive P300 auditory evoked potential measurements indicate that cognitive brain function is significantly impaired in patients suffering from stable end-stage heart failure. Successful cardiac transplantation is effective to fully normalize impaired brain function. Subsequent relative long-term decline of cognitive brain function after successful cardiac transplantation is strongly suggested to be related to cumulative cyclosporine neurotoxicity.
authors.affiliation: Department of Cardiothoracic Surgery, University of Vienna, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Grimm
authors.forename: W
authors.initials: W
authors.lastname: Yeganehfar
authors.forename: G
authors.initials: G
authors.lastname: Laufer
authors.forename: C
authors.initials: C
authors.lastname: Madl
authors.forename: L
authors.initials: L
authors.lastname: Kramer
authors.forename: E
authors.initials: E
authors.lastname: Eisenhuber
authors.forename: P
authors.initials: P
authors.lastname: Simon
authors.forename: N
authors.initials: N
authors.lastname: Kupilik
authors.forename: W
authors.initials: W
authors.lastname: Schreiner
authors.forename: R
authors.initials: R
authors.lastname: Pacher
authors.forename: B
authors.initials: B
authors.lastname: Bunzel
authors.forename: E
authors.initials: E
authors.lastname: Wolner
authors.forename: G
authors.initials: G
authors.lastname: Grimm
mesh_terms: D000339:Affect; D001921:Brain / Q000503:physiopathology*; D003071:Cognition / Q000187:drug effects*; D016572:Cyclosporine / Q000009:adverse effects*; D005072:Evoked Potentials, Auditory; D005260:Female; D005544:Forecasting; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011594:Psychometrics / Q000379:methods; D011788:Quality of Life; D011930:Reaction Time
chemical_list: D016572:Cyclosporine