J Korean Med Sci.  2017 Mar;32(3):457-464. 10.3346/jkms.2017.32.3.457.

Clinical Characteristics of Transplant-associated Encephalopathy in Children

• Lee YJ
• Yum MS
• Kim EH
• Kim MJ
• Kim KM
• Im HJ
• Kim YH
• Park YS
• Ko TS

• KMID: 2366642
• DOI: http://doi.org/10.3346/jkms.2017.32.3.457

Abstract

We aimed to analyze characteristics of encephalopathy after both hematopoietic stem cell and solid organ pediatric transplantation. We retrospectively reviewed medical records of 662 pediatric transplant recipients (201 with liver transplantation [LT], 55 with heart transplantation [HT], and 67 with kidney transplantation [KT], 339 with allogeneic hematopoietic stem cell transplantation [HSCT]) who received their graft organs at Asan Medical Center between January 2000 and July 2014. Of the 662 patients, 50 (7.6%) experienced encephalopathy after transplantation. The incidence of encephalopathy was significantly different according to the type of organ transplant: LT, 16/201 (8.0%), HT, 13/55 (23.6%), KT, 5/67 (7.5%), and HSCT, 16/339 (4.7%) (P < 0.001). Drug-induced encephalopathy (n = 14) was the most common encephalopathy for all transplant types, but particularly after HSCT. Hypertensive encephalopathy was the most common after KT and HT, whereas metabolic encephalopathy was the most common after LT. The median time to encephalopathy onset also differed according to the transplant type: 5 days after KT (range 0-491 days), 10 days after HT (1-296 days), 49.5 days after HSCT (9-1,405 days), and 39 days after LT (1-1,092 days) (P = 0.018). The mortality rate among patients with encephalopathy was 42.0% (n = 21/50). Only 5 patients died of neurologic complications. Transplant-associated encephalopathy presented different characteristics according to the type of transplant. Specialized diagnostic approach for neurologic complications specific to the type of transplant may improve survival and quality of life in children after transplantation.

Keyword

Encephalopathy; Transplantation; Liver; Kidney; Heart; Hematopoietic Stem Cells

MeSH Terms

Brain Diseases*
Brain Diseases, Metabolic
Child*
Chungcheongnam-do
Heart
Heart Transplantation
Hematopoietic Stem Cell Transplantation
Hematopoietic Stem Cells
Humans
Hypertensive Encephalopathy
Incidence
Kidney
Kidney Transplantation
Liver
Liver Transplantation
Medical Records
Mortality
Quality of Life
Retrospective Studies
Transplant Recipients
Transplantation
Transplants

Figure

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  Fig. 1 The incidence of encephalopathy according to the type of organ transplant. LT = liver transplantation, HT = heart transplantation, KT = kidney transplantation, HSCT = hematopoietic stem cell transplantation.

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  Fig. 2 The etiology of encephalopathy according to the type of organ transplant. LT = liver transplantation, HT = heart transplantation, KT = kidney transplantation, HSCT = hematopoietic stem cell transplantation, CNS = central nervous system. *P = 0.006; †P = 0.004; ‡P = 0.002.

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