[Neurological complications in a series of 205 orthotopic heart transplant patients]. / Complicaciones neurológicas en una serie de 205 trasplantes cardíacos ortotópicos.

INTRODUCTION: A heart transplant is the only effective therapeutic option open to many patients with severe heart failure and performing such an intervention is not free of complications. Little is known about the risk factors for neurological complications after a heart transplant. AIMS: The aim of this study was to identify the risk factors for neurological complications following a heart transplant and, more especially, those associated with epileptic seizures, encephalopathy, cerebrovascular accidents (CVA) and headaches. PATIENTS AND METHODS: We conducted a retrospective review of the records of 205 orthotopic heart transplant patients and collected clinical, haemodynamic and laboratory data before, during and after the intervention, using a standardised protocol. RESULTS: 95 patients (48%) presented neurological complications. Their frequencies were as follows: encephalopathy (16.6%), epileptic seizures (13.6%), neuromuscular disorders (10.6%), headaches (10.6%), CVA (10.1%), psychiatric disorders (2.2%) and infection of the central nervous system (2.2%). The risk factors for encephalopathy were post-transplant renal failure (RR: 4.6; CI 95%: 1.4-15), post-transplant hepatic failure (RR: 5.6; CI 95%: 1.5-22) and pre-transplant haemodynamic instability (RR: 4.3; CI 95%: 1.3-14); for epileptic seizures they were a cardiac index of < or = 2 L/min/m2 (RR: 23.8; CI 95%: 2-247) and extracorporeal circulation time > or = 115 min (RR: 11.3; CI 95%: 1-79); and for CVA the risk factor was post-transplant hepatic failure (RR: 12.9; CI 95%: 2.5-66). CONCLUSIONS: Neurological complications often occur after a transplant and are transient. Perioperative haemodynamic instability giving rise to cerebral ischemia and the metabolic disorders secondary to multiple organ failure are determining factors of encephalopathy, epileptic seizures and CVA.

Complicaciones neurológicas en una serie de 205 trasplantes cardíacos ortotópicos / Neurological complications in a series of 205 orthotopic heart transplant patients

Introducción. El trasplante cardíaco es la única opción terapéutica efectiva para muchos pacientes con insuficiencia cardíaca grave, pero su realización no está exenta de complicaciones. Los factores de riesgo de complicaciones neurológicas después del trasplante cardíaco se conocen poco. Objetivos. Identificar los factores de riesgo de complicaciones neurológicas tras un trasplante cardíaco, especialmente los asociados con crisis epilépticas, encefalopatía, accidente cerebrovascular (ACV) y cefalea. Pacientes y métodos. Se revisaron de forma retrospectiva las historias clínicas de 205 pacientes con trasplantes cardíacos ortotópicos y se recogieron los datos clínicos, hemodinámicos y de laboratorio, antes, durante y después de la cirugía, según un protocolo estandarizado. Resultados. Hubo 95 pacientes (48 por ciento) que presentaron complicaciones neurológicas. Fueron encefalopatía (16,6 por ciento), crisis epilépticas (13,6 por ciento), alteración neuromuscular (10,6 por ciento), cefalea (10,6 por ciento), ACV (10,1 por ciento), trastornos psiquiátricos (2,2 por ciento) e infección del sistema nervioso central (2,2 por ciento). Los factores de riesgo para la encefalopatía fueron la insuficiencia renal postrasplante (RR: 4,6; IC 95 por ciento: 1,4-15), la insuficiencia hepática postrasplante (RR: 5,6; IC 95 por ciento: 1,5-22) y la inestabilidad hemodinámica pretrasplante (RR: 4,3; IC 95 por ciento: 1,3-14); para las crisis epilépticas fueron índice cardíaco = 115 min (RR: 11,3; IC 95 por ciento: 1-79), y para el ACV fue la insuficiencia hepática postrasplante (RR: 12,9; IC 95 por ciento: 2,5-66). Conclusiones. Las complicaciones neurológicas postrasplante son frecuentes y transitorias. La inestabilidad hemodinámica perioperatoria productora de isquemia cerebral y las alteraciones metabólicas secundarias a fallo multiorgánico son determinantes de encefalopatía, crisis epilépticas y ACV (AU)

Introduction. A heart transplant is the only effective therapeutic option open to many patients with severe heart failure and performing such an intervention is not free of complications. Little is known about the risk factors for neurological complications after a heart transplant. Aims. The aim of this study was to identify the risk factors for neurological complications following a heart transplant and, more especially, those associated with epileptic seizures, encephalopathy, cerebrovascular accidents (CVA) and headaches. Patients and methods. We conducted a retrospective review of the records of 205 orthotopic heart transplant patients and collected clinical, haemodynamic and laboratory data before, during and after the intervention, using a standardised protocol. Results. 95 patients (48%) presented neurological complications. Their frequencies were as follows: encephalopathy (16.6%), epileptic seizures (13.6%), neuromuscular disorders (10.6%), headaches (10.6%), CVA (10.1%), psychiatric disorders (2.2%) and infection of the central nervous system (2.2%). The risk factors for encephalopathy were post-transplant renal failure (RR: 4.6; CI 95%: 1.4-15), post-transplant hepatic failure (RR: 5.6; CI 95%: 1.5-22) and pre-transplant haemodynamic instability (RR: 4.3; CI 95%: 1.3-14); for epileptic seizures they were a cardiac index of ≤ 2 L/min/m2 (RR: 23.8; CI 95%: 2-247) and extracorporeal circulation time ≥ 115 min (RR: 11.3; CI 95%: 1-79); and for CVA the risk factor was post-transplant hepatic failure (RR: 12.9; CI 95%: 2.5-66). Conclusions. Neurological complications often occur after a transplant and are transient. Perioperative haemodynamic instability giving rise to cerebral ischemia and the metabolic disorders secondary to multiple organ failure are determining factors of encephalopathy, epileptic seizures and CVA (AU)