Abstract 17484: Prevalence, Prognosis and Predictors of Neurological Complications After Heart Transplantation

Abstract

Introduction: Heart transplantation (HT) is the gold-standard treatment for end-stage heart failure. In spite of its benefits, this therapy still involves complications. Among them, neurological complications may impact significantly patient’s morbidity and mortality. The aim of this study is to identify the prevalence, prognosis and predictors of neurological complications after HT. Methods: Data from all patients who underwent orthotopic HT between 2007 and 2017 in a single center were collected and analyzed. Neurological complications were defined as seizures, ischemic and hemorrhagic stroke. Univariate and multivariate analysis were performed to identify significant predictors and ROC curves were generated to determine cutoff values that could influence the presence of neurological complications. Results: We assessed 132 patients from 15-76 years of age, mean age of 51.8 (73.5% men), who were mainly in INTERMACS profile 3 (78.8%). Cardiomyopathy etiologies included Chagas disease (26.7%), ischemic cardiomyopathy (26.7%), idiopathic dilated (24.4%) and other etiologies (22.2%). Neurological events before transplant were present in 16.7%. Neurological complications after HT occurred in 17.4% of patients (8.7% ischemic stroke, 60.9% hemorrhagic stroke and 30.4% seizures), mainly in the first 10 postoperative days (71.4%) and were not related to a higher mortality risk (p=0.159). In the multivariate analysis, pre-transplant adrenaline use (p-value=0.044; 95% CI of 1.07-179.25, OR 13.84) and the difference between mean systolic blood pressure before HT and on the 3rd postoperative day (p-value=0.011; 95% CI of 1.38-11.56, OR 3.99) were independent predictors of neurological complications. A cutoff value higher than 32 mmHg (between mean systolic blood pressure before HT and on the 3rd postoperative day) increased the risk of neurological complications (64.3% sensitivity, 63% specificity; AUROC 0.652). Conclusion: In this single center study, prevalence of neurological complications was high, however had no impact on prognosis. Pre-transplant adrenaline use and systolic blood pressure elevation in the 3rd postoperative day in comparison to the pre-transplant period were predictors of neurological complications.