NEUROLOGIC COMPLICATIONS OF PEDIATRIC HEART-TRANSPLANTATION

Objective: To determine the type and frequency of acquired neurologic complications in survivors of pediatric heart transplantation (HT). De sign: Retrospective study. Setting: Tertiary care children's hospital. Participants: Fourteen survivors of 17 consecutive patients who under went HT during a 60-month period beginning in January 1986. Interventi ons: None. Measurements or Main Results: Three distinct subgroups of p atients who had undergone HT were identified: six infants with uncorre cted hypoplastic left heart syndrome (HLHS), three infants with HLHS w ho had undergone previous stage 1 Nonwood repair, and eight older chil dren with end-stage cardiomyopathy. Fourteen (82%) of 17 children were alive at follow-up. Only one patient (7%) had a significant acquired neurologic deficit (left temporal lobe stroke with subsequent seizures in an infant with uncorrected HLHS). The remaining subjects had norma l results of post-HT neurologic examinations (n=7), minor post-FIT neu rologic abnormalities (n=3), no significant change in preexisting neur ologic abnormalities (n=1), or normal neurologic status by report (n=2 ). The minor neurologic abnormalities noted post-FIT were dysmetria, t remor, and absent reflexes. No episodes of choreoathetosis or cyclospo rine-related seizures were seen. Conclusions: Pediatric HT is associat ed with both a high survival rate and a low incidence of severe acquir ed neurologic deficits despite a significant incidence of severe syste mic and metabolic derangements in the pretransplantation and posttrans plantation periods. In infants with HLHS, HT seems to carry a lower in cidence of severe neurologic morbidity (12%) than other surgical treat ments.