title: Effect of neurologic complications on outcome after heart transplant.
abstract: OBJECTIVE
  To study neurologic complications after heart transplant.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Cardiac transplant program at Mayo Clinic, Rochester, Minnesota.
  
  
  METHODS
  We retrospectively studied 313 patients who underwent heart transplant at Mayo Clinic Rochester from January 1, 1988, through October 31, 2006.
  
  
  METHODS
  Neurologic symptoms, neurologic complications, score on the Glasgow Outcome Scale, and mortality.
  
  
  RESULTS
  Causes of end-stage heart failure were idiopathic dilated myopathy (34%), ischemic heart failure (29%), congenital disorders (12%), amyloidosis (11%), and miscellaneous (15%). Perioperative neurologic complications occurred in 23% of patients and included delirium or encephalopathy (9%), cerebrovascular complications (5%), and diseases of the peripheral nerves and muscles (4%); however, only perioperative cerebrovascular complications were associated with 1-year mortality (hazard ratio, 4.17; 95% confidence interval, 1.04-16.76; P = .04). Most of these cerebrovascular complications occurred after the second postoperative day and were related to mechanical support of the circulation. Over 18 years, the risk for neurologic complications was 81%: sleeping disorders, 32%; polyneuropathy, 26%; and cerebrovascular diseases, 14%. Cause of death was neurologic in 12 of 95 patients (13%), and the most common were cerebrovascular disease (n = 6) and central nervous system infectious diseases (n = 3). Adjusting for baseline predictors, central nervous system infection (hazard ratio, 4.29; 95% confidence interval, 1.69-10.91; P = .002), depression (hazard ratio, 1.81; 95% confidence interval, 1.06-3.09; P = .03), and seizures (hazard ratio, 3.44; 95% confidence interval, 1.33-8.85; P = .01) were predictive for mortality.
  
  
  CONCLUSIONS
  Perioperative neurologic complications are frequent in heart transplant recipients, but most are transient and inconsequential. However, perioperative stroke is the most important neurologic complication affecting survival in the first year after heart transplant. Infectious diseases of the central nervous system are associated with fatal outcome.
authors.affiliation: Department of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Diederik
authors.initials: D
authors.lastname: van de Beek
authors.forename: Walter
authors.initials: W
authors.lastname: Kremers
authors.forename: Richard C
authors.initials: RC
authors.lastname: Daly
authors.forename: Brooks S
authors.initials: BS
authors.lastname: Edwards
authors.forename: Alfredo L
authors.initials: AL
authors.lastname: Clavell
authors.forename: Christopher G A
authors.initials: CG
authors.lastname: McGregor
authors.forename: Eelco F M
authors.initials: EF
authors.lastname: Wijdicks
mesh_terms: D000293:Adolescent; D000328:Adult; D002494:Central Nervous System Infections / Q000453:epidemiology / Q000209:etiology; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003863:Depression / Q000453:epidemiology / Q000209:etiology; D005260:Female; D023261:Glasgow Outcome Scale; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D016017:Odds Ratio; D011115:Polyneuropathies / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012640:Seizures / Q000453:epidemiology / Q000209:etiology; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000209:etiology