ABSTRACT
INTRODUCTION: Neurological complications (NC) are a significant cause of morbidity and mortality in paediatric patients receiving solid organ transplants. Our aim was to describe the experience of our hospital with NC in paediatric patients receiving heart, lung and liver transplants. PATIENTS AND METHODS: A retrospective study was conducted on 140 paediatric patients who received a solid organ transplant during the period 2000-2011. RESULTS: A total of 23 paediatric solid organ transplant recipients (16.4% of cases), with a median age of 6 years, had NC. The symptoms were, in order of frequency: acute symptomatic seizures (12 patients); acute encephalopathy (11 patients); neuromuscular weakness (4 children), tremor (4 children), headache (2 children), neuropathic pain (2 children), and visual disturbances (2 children). The aetiologies of NC were: the neurotoxicity of the immunosuppressive drugs (12 patients), post-hypoxic-ischaemic encephalopathy (6 patients), infections (2 cases), mechanical compression of peripheral nerve during surgery (2 cases), and a metabolic complication (1 case). The five patients who met the criteria of posterior reversible encephalopathy syndrome had a favourable outcome. Seven patients died, four of them due to hypoxic-ischaemic encephalopathy. CONCLUSIONS: NC are common in paediatric patients receiving heart, liver, lung, and renal transplants, with acute symptomatic seizures and acute encephalopathy being the most common clinical signs. No differences were found in the NC with the different types of transplants. Neurotoxicity of the immunosuppressive drugs and hypoxic-ischaemic encephalopathy were the main causes of NC, having different management and outcomes. The prognosis was favourable in most of the patients, except for those who had moderate or severe post-hypoxic-ischaemic damage.
Subject(s)
Heart Transplantation/adverse effects , Liver Transplantation/adverse effects , Lung Transplantation/adverse effects , Nervous System Diseases/etiology , Child , Female , Humans , Male , Retrospective StudiesABSTRACT
La microdeleción 22q11 es una deleción genética frecuente con variabilidad fenotípica amplia. Engloba una serie de síndromes, entre los que destaca el síndrome de DiGeorge. Las manifestaciones clínicas más frecuentemente descritas son malformaciones cardiacas, una facies característica, malformaciones palatinas, hipoparatiroidismo, inmunodeficiencia secundaria a hipoplasia tímica, retraso psicomotor y alteraciones psiquiátricas. Dentro de los signos producidos por la enfermedad, es frecuente la insuficiencia respiratoria de causa multifactorial. Las malformaciones de la vía aérea son frecuentes, aunque en la mayoría de los pacientes son leves, por lo que no suelen producir sintomatología. Sin embargo, en algunos casos pueden condicionar clínica respiratoria grave. Los casos clínicos presentados ilustran la importancia de la valoración precoz de la vía aérea mediante fibrobroncoscopia en pacientes con microdeleción 22q11 que presentan dificultad respiratoria recurrente(AU)
The 22q11 deletion syndrome is a frequent contiguous-gene deletion syndrome. This disorder has a broad spectrum of phenotypic manifestations. It includes various syndromes such as DiGeorge syndrome. The most frequent clinical manifestations are congenital cardiac defects, characteristic facies, palate malformations, hypoparathyroidism, immunodeficiency due to thymic hypoplasia, growth retardation, and behavioural and psychiatric problems. Among the symptoms observed, many patients suffer from respiratory insufficiency or failure. The origin is often multifactorial. Structural airway abnormalities are frequently found in this syndrome. In many of these patients the malformation is mild or non-existent, and remains asymptomatic. However, in some cases it can cause a severe respiratory insufficiency, being diagnosed when other disorders are ruled out. These cases illustrate the importance of early visualisation of the airway by fibrobronchoscopy in the management of the patient with 22q11 deletion syndrome who has recurrent respiratory difficulties(AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Child , 22q11 Deletion Syndrome/complications , 22q11 Deletion Syndrome/diagnosis , Cardiovascular Diseases/complications , Bronchoscopy/methods , Bronchoscopy , Oxygen Inhalation Therapy , Bronchial Spasm/complications , Bronchial Spasm/diagnosis , Pneumonia/complications , 22q11 Deletion Syndrome/physiopathology , 22q11 Deletion Syndrome , Causality , Hypercapnia/complications , Bronchial Spasm/therapy , Bronchial Spasm , Radiography, Thoracic/methods , Adrenal Cortex Hormones/therapeutic use , Bronchodilator Agents/therapeutic use , Azithromycin/therapeutic useABSTRACT
The 22q11 deletion syndrome is a frequent contiguous-gene deletion syndrome. This disorder has a broad spectrum of phenotypic manifestations. It includes various syndromes such as DiGeorge syndrome. The most frequent clinical manifestations are congenital cardiac defects, characteristic facies, palate malformations, hypoparathyroidism, immunodeficiency due to thymic hypoplasia, growth retardation, and behavioural and psychiatric problems. Among the symptoms observed, many patients suffer from respiratory insufficiency or failure. The origin is often multifactorial. Structural airway abnormalities are frequently found in this syndrome. In many of these patients the malformation is mild or non-existent, and remains asymptomatic. However, in some cases it can cause a severe respiratory insufficiency, being diagnosed when other disorders are ruled out. These cases illustrate the importance of early visualisation of the airway by fibrobronchoscopy in the management of the patient with 22q11 deletion syndrome who has recurrent respiratory difficulties.
