Clinical Characteristics of Transplant-associated Encephalopathy in Children.
We aimed to analyze characteristics of encephalopathy after both hematopoietic stem cell and solid organ pediatric transplantation. We retrospectively reviewed medical records of 662 pediatric transplant recipients (201 with liver transplantation [LT], 55 with heart transplantation [HT], and 67 with kidney transplantation [KT], 339 with allogeneic hematopoietic stem cell transplantation [HSCT]) who received their graft organs at Asan Medical Center between January 2000 and July 2014. Of the 662 patients, 50 (7.6%) experienced encephalopathy after transplantation. The incidence of encephalopathy was significantly different according to the type of organ transplant: LT, 16/201 (8.0%), HT, 13/55 (23.6%), KT, 5/67 (7.5%), and HSCT, 16/339 (4.7%) (P < 0.001). Drug-induced encephalopathy (n = 14) was the most common encephalopathy for all transplant types, but particularly after HSCT. Hypertensive encephalopathy was the most common after KT and HT, whereas metabolic encephalopathy was the most common after LT. The median time to encephalopathy onset also differed according to the transplant type: 5 days after KT (range 0-491 days), 10 days after HT (1-296 days), 49.5 days after HSCT (9-1,405 days), and 39 days after LT (1-1,092 days) (P = 0.018). The mortality rate among patients with encephalopathy was 42.0% (n = 21/50). Only 5 patients died of neurologic complications. Transplant-associated encephalopathy presented different characteristics according to the type of transplant. Specialized diagnostic approach for neurologic complications specific to the type of transplant may improve survival and quality of life in children after transplantation.
Department of Pediatrics, Kyungpook National University Hospital, Daegu, Korea.
Yun Jeong
http://orcid.org/0000-0003-3472-5336
YJ
Lee
Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
Mi Sun
http://orcid.org/0000-0003-1311-3955
MS
Yum
Department of Pediatrics, CHA Gangnam Medical Center, CHA University, Seoul, Korea.
Eun Hee
http://orcid.org/0000-0003-3143-9545
EH
Kim
Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
Min Jee
http://orcid.org/0000-0002-8081-6522
MJ
Kim
Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
Kyung Mo
http://orcid.org/0000-0001-7896-6751
KM
Kim
Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
Ho Joon
http://orcid.org/0000-0001-8799-4068
HJ
Im
Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
Young Hwue
http://orcid.org/0000-0001-7960-4752
YH
Kim
Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
Young Seo
http://orcid.org/0000-0001-7653-2036
YS
Park
Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea. tsko@amc.seoul.kr.
Tae Sung
http://orcid.org/0000-0002-8213-8964
TS
Ko
D000293:Adolescent; D001794:Blood Pressure / Q000502:physiology; D001927:Brain Diseases / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000517:prevention & control; D016027:Heart Transplantation / Q000009:adverse effects*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015994:Incidence; D007223:Infant; D016030:Kidney Transplantation / Q000009:adverse effects*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D012189:Retrospective Studies; D014184:Transplantation, Homologous
D007166:Immunosuppressive Agents
Encephalopathy; Heart; Hematopoietic Stem Cells; Kidney; Liver; Transplantation