Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA.
Department of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, USA.
J Heart Lung Transplant. 2018 Jun;37(6):733-739. doi: 10.1016/j.healun.2017.12.016. Epub 2018 Jan 9.
Major neurologic events (MNEs) after heart transplantation (HTx) and their effect on survival have not been well described in children. In this study we aimed to characterize early MNEs (stroke, isolated seizures not from stroke and posterior reversible leukoencephalopathy [PRES] within 1 year after primary pediatric HTx) and evaluate their impact on 1-year post-HTx survival. We hypothesized that early an MNE after HTx is associated with decreased 1-year patient survival.
We performed a pediatric, single-center, retrospective analysis of 345 consecutive patients aged 0 to 22 years who underwent primary HTx during the period from November 1, 1994 to October 31, 2015. Characteristics were compared between patients with and without early MNEs.
Nineteen percent (65 of 345) of patients had an MNE within 1 year after HTx (median 9 days, interquartile range [IQR] 4 to 23 days). Freedom from early MNE was 97%, 85% and 80% at 1, 6 and 12 months, respectively. Of the total 65 events, stroke comprised 55.4% (n = 36), isolated seizure 29.2% (n = 19) and PRES 15.4% (n = 10). With multiple logistic regression, previous neurologic disease, infection requiring intravenous antibiotic therapy and post-operative drug-treated hypertension were found to be significant risk factors for early MNEs. Stroke (hazard ratio 4.1, IQR 2.3 to 7.6, p < 0.0001), but not seizures and PRES, was associated with decreased 1-year patient survival.
Major neurologic events are common after pediatric HTx and usually occur within the first few weeks. Early stroke was associated with decreased 1-year survival. Potentially modifiable factors, including prior neurologic event, drug-treated hypertension and infection, were associated with increased risk of developing early MNEs.
心脏移植（HTx）后发生的主要神经系统事件（MNEs）及其对生存的影响在儿童中尚未得到很好描述。在这项研究中，我们旨在描述早期 MNEs（中风、非中风孤立性发作和移植后可逆性后部白质脑病[PRES]，发生在儿童 HTx 后 1 年内），并评估其对 HTx 后 1 年的生存影响。我们假设 HTx 后早期发生 MNE 与 1 年患者生存率降低有关。
我们对 1994 年 11 月 1 日至 2015 年 10 月 31 日期间接受初次 HTx 的 345 例 0 至 22 岁连续患者进行了一项儿科、单中心、回顾性分析。比较了有和无早期 MNEs 患者的特征。
19%（65/345）的患者在 HTx 后 1 年内发生 MNE（中位数 9 天，四分位距[IQR]4 至 23 天）。无早期 MNE 的 1 个月、6 个月和 12 个月的生存率分别为 97%、85%和 80%。在总共 65 例事件中，中风占 55.4%（n = 36），孤立性癫痫发作占 29.2%（n = 19），PRES 占 15.4%（n = 10）。多因素逻辑回归分析发现，既往神经系统疾病、需要静脉使用抗生素治疗的感染和术后药物治疗性高血压是早期 MNEs 的显著危险因素。中风（危险比 4.1，IQR 2.3 至 7.6，p < 0.0001），而非癫痫发作和 PRES，与 1 年患者生存率降低相关。
儿童 HTx 后 MNEs 很常见，通常发生在最初几周内。早期中风与 1 年生存率降低有关。包括既往神经系统事件、药物治疗性高血压和感染在内的潜在可改变因素与发生早期 MNEs 的风险增加有关。
