Neuropediatrics 2006; 37 - TP67
DOI: 10.1055/s-2006-945660

CLINICAL FACTORS ASSOCIATED WITH POSTMORTEM CNS ABNORMALITIES FOLLOWING CARDIAC TRANSPLANTATION

C McClure 1, S Hutson 2, D Deming 3, J Johnston 4, C Zuppan 5, J Fitts 4, R Chinnock 6, S Ashwal 1
  • 2Loma Linda University School of Medicine:
  • 6Department of Pediatrics
  • 1Division of Child Neurology
  • 3Division of Neonatology
  • 4Department of Cardiothoracic surgery
  • 5Department of Pathology

Objectives: Over a 17-year period (1986–2003), 405 children underwent cardiac transplantation at Loma Linda University Children’s Hospital. We reviewed the autopsy findings and clinical records of those who died to determine if a relationship between CNS abnormalities, functional cardiac disease and clinical presentation existed.

Methods: We compiled the number and type of intracranial lesions present on postmortem examination, and matched these to underlying functional congenital heart disease, perisurgical interventions, neuroimaging, and EEG results. Nonparametric statistics (Mann-Whitney U and Spearman’s rank correlation) were employed to determine whether these groupings had association with CNS abnormality types.

Results: One hundred thirty-six children died following orthotopic cardiac transplantation. Of these, approximately 86% underwent autopsies, and the brain was examined in 61% (n=82). The mean age at death was 4.8 + 5.4 years, with a range 1 month to 24 years. The male/female ratio was 39/43. Intracranial abnormalities were found in 87%. Mann-Whitney U testing revealed that those children with CNS necrosis had cardiopulmonary bypass times of greater than 90 minutes (Z=-2.231, p=0.026), while CNS extraparenchymal hemorrhaging, and infarctive changes, each had postsurgical survival times of less than 60 days (Z=-4.95, p=0.000, and Z=-2.37, p=0.018, respectively). Pretransplant cardiac arrest was correlative to perioperative seizures (pre: r=0.39, p=0.000 and post: r=0.28, p=0.011). The presence of seizures following transplantation correlated to abnormal post-transplant neuroimaging (head CT: r=0.28, p=0.010 and head MRI: r=0.40, p=0.000).

Conclusion: Prolonged cardiopulmonary bypass time, and perioperative seizures, may be predictive of worse cardiac functioning and neurologic outcome following transplantation. Adequately recognizing these clinical factors may allow for more timely and aggressive clinical interventions.