Neurological Complications in Patients with Heart Transplantation

Amra Sakusic; Alejandro A. Rabinstein

doi:10.1055/s-0041-1726285

Seminars in Neurology, Table of Contents

Semin Neurol 2021; 41(04): 447-452
DOI: 10.1055/s-0041-1726285

Review Article

Neurological Complications in Patients with Heart Transplantation

Amra Sakusic

¹Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida

²Multidisciplinary Epidemiology and Translational Research in Intensive Care, Emergency and Perioperative Medicine (METRIC), Mayo Clinic, Rochester, Minnesota

,

Alejandro A. Rabinstein

³Department of Neurology, Mayo Clinic, Rochester, Minnesota

› Author Affiliations

Abstract

Neurological complications after heart transplantation are common and include cerebrovascular events (ischemic strokes, hemorrhagic strokes, and transient ischemic attacks), seizures, encephalopathy, central nervous system (CNS) infections, malignancies, and peripheral nervous system complications. Although most neurological complications are transient, strokes and CNS infections can result in high mortality and morbidity. Early recognition and timely management of these serious complications are crucial to improve survival and recovery. Diagnosing CNS infections can be challenging because their clinical presentation can be subtle in the setting of immunosuppression. Immunosuppressive medications themselves can cause a broad spectrum of neurological complications including seizures and posterior reversible encephalopathy syndrome. This article provides a review of the diagnosis and management of neurological complications after cardiac transplantation.

Keywords

neurological complications - heart transplantation - cerebrovascular events - central nervous system infections - seizures

Full Text

References

References
1 Lund LH, Khush KK, Cherikh WS. et al; International Society for Heart and Lung Transplantation. The Registry of the International Society for Heart and Lung Transplantation: Thirty-fourth Adult Heart Transplantation Report-2017; Focus Theme: allograft ischemic time. J Heart Lung Transplant 2017; 36 (10) 1037-1046
2 Benjamin EJ, Muntner P, Alonso A. et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2019 update: a report from the American Heart Association. Circulation 2019; 139 (10) e56-e528
3 Benjamin EJ, Blaha MJ, Chiuve SE. et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2017 Update: a report from the American Heart Association. Circulation 2017; 135 (10) e146-e603
4 Heidenreich PA, Albert NM, Allen LA. et al; American Heart Association Advocacy Coordinating Committee, Council on Arteriosclerosis, Thrombosis and Vascular Biology, Council on Cardiovascular Radiology and Intervention, Council on Clinical Cardiology, Council on Epidemiology and Prevention, Stroke Council. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail 2013; 6 (03) 606-619
5 Wever-Pinzon O, Edwards LB, Taylor DO. et al. Association of recipient age and causes of heart transplant mortality: implications for personalization of post-transplant management - an analysis of the International Society for Heart and Lung Transplantation Registry. J Heart Lung Transplant 2017; 36 (04) 407-417
6 McCartney SL, Patel C, Del Rio JM. Long-term outcomes and management of the heart transplant recipient. Best Pract Res Clin Anaesthesiol 2017; 31 (02) 237-248
7 Heroux A, Pamboukain S. Neurologic aspects of heart transplantation. In: Biller J, Ferro JM. eds. Handbook of Clinical Neurology. Illinois: Elsevier B.V.; 2014: 1229-1236
8 van de Beek D, Kremers W, Daly RC. et al. Effect of neurologic complications on outcome after heart transplant. Arch Neurol 2008; 65 (02) 226-231
9 Belvís R, Martí-Fàbregas J, Cocho D. et al. Cerebrovascular disease as a complication of cardiac transplantation. Cerebrovasc Dis 2005; 19 (04) 267-271
10 Zierer A, Melby SJ, Voeller RK. et al. Significance of neurologic complications in the modern era of cardiac transplantation. Ann Thorac Surg 2007; 83 (05) 1684-1690
11 Malheiros SMF, Almeida DR, Massaro AR. et al. Neurologic complications after heart transplantation. Arq Neuropsiquiatr 2002; 60 (2-A): 192-197
12 Pérez-Miralles F, Sánchez-Manso JC, Almenar-Bonet L, Sevilla-Mantecón T, Martínez-Dolz L, Vílchez-Padilla JJ. Incidence of and risk factors for neurologic complications after heart transplantation. Transplant Proc 2005; 37 (09) 4067-4070
13 Cemillán CA, Alonso-Pulpón L, Burgos-Lázaro R, Millán-Hernández I, del Ser T, Liaño-Martínez H. [Neurological complications in a series of 205 orthotopic heart transplant patients]. Rev Neurol 2004; 38 (10) 906-912
14 Navarro V, Varnous S, Galanaud D. et al. Incidence and risk factors for seizures after heart transplantation. J Neurol 2010; 257 (04) 563-568
15 Urbanowicz T, Pawłowska M, Buczkowski P. et al. Seizures after heart transplantation--two cases of non-immunosuppressant drug interactions in young patients. Ann Transplant 2014; 19: 417-420
16 Fugate JE, Rabinstein AA. Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions. Lancet Neurol 2015; 14 (09) 914-925
17 Hotson JR, Pedley TA. The neurological complications of cardiac transplantation. Brain 1976; 99 (04) 673-694
18 Dhar R, Human T. Central nervous system complications after transplantation. Neurol Clin 2011; 29 (04) 943-972
19 van de Beek D, Patel R, Daly RC, McGregor CG, Wijdicks EF. Central nervous system infections in heart transplant recipients. Arch Neurol 2007; 64 (12) 1715-1720
20 Gomez AJ, Waggoner JJ, Itoh M. et al. Fatal West Nile virus encephalitis in a heart transplant recipient. J Clin Microbiol 2015; 53 (08) 2749-2752
21 Schwartzmann PV, Ramalho LNZ, Neder L. et al. Zika virus meningoencephalitis in an immunocompromised patient. Mayo Clin Proc 2017; 92 (03) 460-466
22 Hall WA, Martinez AJ, Dummer JS. et al. Central nervous system infections in heart and heart-lung transplant recipients. Arch Neurol 1989; 46 (02) 173-177
23 Muñoz P, Valerio M, Palomo J. et al. Infectious and non-infectious neurologic complications in heart transplant recipients. Medicine (Baltimore) 2010; 89 (03) 166-175
24 Marchiori PE, Alexandre PL, Britto N. et al. Late reactivation of Chagas' disease presenting in a recipient as an expansive mass lesion in the brain after heart transplantation of chagasic myocardiopathy. J Heart Lung Transplant 2007; 26 (11) 1091-1096
25 Öcal R, Kibaroğlu S, Derle E. et al. Neurologic complications after cardiac transplant. Exp Clin Transplant 2016;1(01):
26 Pruitt AA, Graus F, Rosenfeld MR. Neurological complications of solid organ transplantation. Neurohospitalist 2013; 3 (03) 152-166
27 Cano EJ, Robinson MT, Eidelman BH, Sebesto JR, Helmer SE, Freeman WD. Asymmetric brain edema after cardiac transplantation: cerebroautoregulatory failure and relative hyperperfusion. Transplant Proc 2015; 47 (01) 194-197
28 Mateen FJ, van de Beek D, Kremers WK. et al. Neuromuscular diseases after cardiac transplantation. J Heart Lung Transplant 2009; 28 (03) 226-230
29 Adair J, Rose J, Alderson K. Inflammatory polyneuropathy after heart transplantation. Its association with antibodies to asialo-GM1 and sulfatide. Transplantation 1993; 56 (06) 1597-1599
30 Perea M, Picón M, Miró O, Orús J, Roig E, Grau JM. Acute quadriplegic myopathy with loss of thick (myosin) filaments following heart transplantation. J Heart Lung Transplant 2001; 20 (10) 1136-1141