Neurologic complications after heart transplantation.
OBJECTIVE
Neurologic complications are known as important cause of morbidity and mortality in orthotopic heart transplantation. Our aim was to identify the frequency and outcome of neurologic complications after heart transplantation in a prospective observational study.


METHODS
From September 93 to September 99, as part of our routine heart transplantation protocol all patients with end-stage cardiac failure were evaluated by the same neurologist before and at the time of any neurologic event (symptom or complaint) after transplantation.


RESULTS
Out of 120 candidates evaluated, 62 were successfully transplanted (53 male; median age 45.5 years, median follow-up 26.8 months). Fifteen patients (24%) had ischemic, 22 (35%) idiopathic, 24 (39%) Chagas' disease and 1 (2%) had congenital cardiomyopathy. Neurologic complications occurred in 19 patients (31%): tremor, severe headache, transient encephalopathy and seizures related to drug toxicity or metabolic changes in 13; peripheral neuropathy in 4; and spinal cord compression in two (metastatic prostate cancer and epidural abscess). No symptomatic postoperative stroke was observed.


CONCLUSIONS
Although frequent, neurologic complications were seldom related to persistent neurologic disability or death. Most of the complications resulted from immunosuppression, however, CNS infection was rare. The absence of symptomatic stroke in our series may be related to the lower frequency of ischemic cardiomyopathy.
Malheiros
Suzana M F
SM
Department of Neurology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil. suzana@sun-nepi.epm.br
Almeida
Dirceu R
DR
Massaro
Ayrton R
AR
Castelo
Adauto
A
Diniz
Rosiane V Z
RV
Branco
João N
JN
Carvalho
Antonio C
AC
Gabbai
Alberto A
AA
D000293:Adolescent; D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000209:etiology; D002561:Cerebrovascular Disorders / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology*; D011446:Prospective Studies; D012307:Risk Factors