Neurologic complications of pediatric lung transplantation.
OBJECTIVE
To report neurologic complications in a large population of pediatric lung transplantation patients.


METHODS
A retrospective review of the first 135 patients to undergo lung transplantation at St. Louis Children's Hospital from July 1990 to December 1997.


RESULTS
Sixty-one (45%) patients had neurologic complications. The most common presenting symptoms were seizures (27%), followed by encephalopathy, headache, depression, and focal neurologic deficits. Cyclosporine toxicity (7%) and hypoxia-ischemia (7%) constituted the most commonly identified etiologies, followed by stroke, metabolic, and infectious causes. Risk factor analysis found that patients with interstitial lung disease had a higher frequency of hypoxic-ischemic events and patients with seizures had significantly elevated trough cyclosporine levels. Patients with stroke and hypoxia had a poor neurologic prognosis, whereas patients with cyclosporine toxicity uniformly had a good outcome.


CONCLUSIONS
Neurologic complications occur frequently after lung transplantation in pediatric patients, with seizures being the most common presenting symptom. Except in patients with stroke and hypoxia, prognosis is generally favorable. Seizures not accompanied by an irreversible structural etiology are unlikely to require long-term treatment with antiepileptic medications. Cyclosporine neurotoxicity typically resolves without requiring discontinuation of immunosuppressive therapy.
Wong
M
M
Department of Neurology, St. Louis Children's Hospital, Washington University School of Medicine, MO 63110, USA.
Mallory
G B
GB
Goldstein
J
J
Goyal
M
M
Yamada
K A
KA
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000009:adverse effects; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007223:Infant; D007231:Infant, Newborn; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D009422:Nervous System Diseases / Q000139:chemically induced / Q000209:etiology*; D011379:Prognosis; D011652:Pulmonary Circulation; D011658:Pulmonary Fibrosis / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000209:etiology; D020521:Stroke / Q000209:etiology; D014652:Vascular Diseases / Q000601:surgery
D007166:Immunosuppressive Agents; D016572:Cyclosporine