Hostname: page-component-669899f699-7xsfk Total loading time: 0 Render date: 2025-04-24T18:50:13.477Z Has data issue: false hasContentIssue false
  • English
  • Français

Neuropathology of Heart Transplantation

Published online by Cambridge University Press:  18 September 2015

L.C. Ang ,
J.M. Gillett  and
J.C.E. Kaufmann
L.C. Ang*
Affiliation:
Department of Pathology, University Hospital and the University of Western Ontario, London
J.M. Gillett
Affiliation:
Department of Clinical Neurological Sciences, University Hospital and the University of Western Ontario, London
J.C.E. Kaufmann
Affiliation:
Department of Pathology, University Hospital and the University of Western Ontario, London
*
Department of Pathology (Neuropathology), University of Saskatchewan, Health Sciences Building, Saskatoon, Saskatchewan, Canada S7N 0W0
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The neuropathology of 18 cardiac transplant recipients was reviewed with the clinical findings. Pathological changes were noted in the central nervous system (CNS) in 94% of the patients, the most frequent being cerebral vascular in origin (72%). Eight patients (44%) had multiple cerebral infarcts and morphologically, a large number of these antedated the transplantation. In addition 4 patients had acute focal ischemic changes which occurred after transplantation. Intracranial hemorrhage was noted in 5 patients (28%), including one case of fatal intracerebral hemorrhage following an acute hypertensive episode after the transplantation. While systemic infection was common (10 patients), there were only 5 cases of intracranial infection; including 3 cases of cytomegalovirus infection, one of candidiasis and one of aspergillosis. Post-transplant seizures, occurring in a third of the patients, were related to a variety of causative factors such as sepsis, intracranial hemorrhage, cerebral ischemia, metabolic encephalopathy and cyclosporin neurotoxicity. Of note in this series was the absence of CNS lymphoma or other systemic lymphoproliferative disorder.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 16 , Issue 3 , August 1989 , pp. 291 - 298
Copyright
Copyright © Canadian Neurological Sciences Federation 1989

References

REFERENCES

1.Barnard, CN: The operation. A human cardiac transplant: An interim report of a successful operation performed at Groofe Schuur Hospital, Capetown. S Afr Med J 1967; 41: 1271–1274.Google Scholar
2.Caves, PK, Stinson, EB, Billingham, ME, et al. Diagnosis of human cardiac allograft rejection by serial cardiac biopsy. J Thorac Cardiovasc Surg 1973; 66: 461–466.CrossRefGoogle ScholarPubMed
3.Rose, AG, Uys, CJ, Losman, JG, et al. Evaluation of endomyocardial biopsy in diagnosis of cardiac rejection. Transplantation 1978; 26: 10–13.CrossRefGoogle ScholarPubMed
4.Hardesty, RL, Griffith, BP, Debstzi, et al. Experience with cyclosporin in cardiac transplantation. Transplant Proc 1983; 15, 4, Suppl 11: 2553–2558.Google Scholar
5.Hotson, JR, Pedley, TA. The neurological complications of cardiac transplantation. Brain 1976; 99: 673–694.CrossRefGoogle ScholarPubMed
6.Schober, R, Herman, MN. Neuropathology in cardiac transplantation: survey of 31 cases. Lancet 1973; 1: 962–994.CrossRefGoogle ScholarPubMed
7.Montero, CG, Martinez, AJ. Neuropathology of heart transplantation: 23 cases. Neurology 1986; 36: 1149–1154.CrossRefGoogle ScholarPubMed
8.Schnede, SA. Neuropathological features of human organ transplantation II. Central pontine myelinolysis and neuroaxonal dystrophy. J Neuropathol Exp Neurol 1966; 25: 18–39.Google Scholar
9.Rubinstein, LJ, Herman, MM, Long, TF, et al. Disseminated necrotizing leukoencephalopathy: A complication of treated central nervous system leukemia and lymphoma. Cancer 1975; 35: 291–305.3.0.CO;2-V>CrossRefGoogle ScholarPubMed
10.Easton, JD, Sherman, DG. Management of cerebral embolism of cardiac origin. Stroke 1980; 11: 433–442.CrossRefGoogle ScholarPubMed
11.Thompson, PL, Robinson, JS. Stroke after acute myocardial infarction: relation to infarct size. Br Med J 1978; 2: 457–459.CrossRefGoogle ScholarPubMed
12.Brierley, JB. Neuropathological findings in patients dying after open-heart surgery. Thorax 1963; 18: 291–304.CrossRefGoogle ScholarPubMed
13.Gilman, S. Cerebral disorders after open-heart operations. N Engl J Med 1965; 272: 489–498.CrossRefGoogle ScholarPubMed
14.Adams, JH, Brierley, JB, Connor, RCR, et al. The effects of systemic hypotension upon the human brain. Clinical and neuropathological observations in 11 cases. Brain 1966; 89: 235–268.CrossRefGoogle ScholarPubMed
15.Brierley, JB, Cooper, JE. Cerebral complications of hypotensive anaesthesia in a healthy adult. J Neurol Neurosurg Psychiatry 1962; 25: 24–30.CrossRefGoogle Scholar
16.Meldrum, BS, Brierley, JB, England, C. Prolonged epileptic seizures in primates. Arch Neurol 1973; 28: 10–17.CrossRefGoogle ScholarPubMed
17.Auer, RN, Siesjo, BK. Biological differences between ischemia, hypoglycemia, and epilepsy. Ann Neurol 1988; 24: 699–707.CrossRefGoogle ScholarPubMed
18.Griffith, BP, Hardesty, RL, Bahnson, HT. Powerful but limited immunosuppression for cardiac transplantation with cyclosporin and low-dose steroid. J Thorac Cardiovasc Surg 1984; 7: 35–42.CrossRefGoogle Scholar
19.Cohen, DJ, Loertscher, R, Rubin, MF, et al. Cyclosporin: A new immunosuppressive agent for organ transplantation. Ann Intern Med 1984; 101: 667–682.CrossRefGoogle ScholarPubMed
20.Laupacis, A. Complications of cyclosporin therapy-A comparison to Azathioprine. Transplant Proc 1983; 5 Suppl 1, 2748–2753.Google Scholar
21.Humphreys, RP, Hoffman, HJ, Mustard, WT, et al. Cerebral hemorrhage following heart surgery. J Neurosurg 1975; 43: 671–675.CrossRefGoogle ScholarPubMed
22.Britt, RH, Enzmann, DR, Remington, JS. Intracranial infection in cardiac transplant recipients. Ann Neurol 1981; 9: 107–119.CrossRefGoogle ScholarPubMed
23.Mason, JW, Stinson, EB, Hunt, SA, et al. Infections after cardiac transplantation: relation to rejection therapy. Ann Intern Med 1976; 85: 69–72.CrossRefGoogle ScholarPubMed
24.Wreghitt, TG, Hakin, M, Gray, JJ, et al. Cytomegalovirus infections in heart and heart and lung transplant recipients. J Clin Pathol 1988; 41: 660–667.CrossRefGoogle ScholarPubMed
25.Parker, JC, McCloskey, JJ, Lee, RS. Human cerebral candidosis - A Postmortem evaluation of 19 patients. Hum Pathol 1981; 12: 23–28.CrossRefGoogle Scholar
26.Walsh, JJ, Hier, OB, Caplan, LR. Aspergillosis of central nervous system: Clinicopathological analysis of 17 patients. Ann Neurol 1985; 18: 574–582.CrossRefGoogle ScholarPubMed
27.Richardson, EP Jr, Dodge, PR. Epilepsy in cerebral vascular disease. A study of the incidence and nature of seizures in 104 consecutive autopsy-proven cases of cerebral infarction and hemorrhage. Epilepsia 1954; 3: 49–65.CrossRefGoogle ScholarPubMed
28.Dodge, PR, Richardson, EP Jr, Victor, M. Recurrent convulsive seizures as a sequel to cerebral infarction; a clinical and pathological study. Brain 1954; 77: 610–638.CrossRefGoogle ScholarPubMed
29.Louis, S, McDowell, F. Epileptic seizures in nonembolic cerebral infarction. Arch Neurol 1967; 17: 414–418.CrossRefGoogle ScholarPubMed
30.Madison, D, Niedermeyer, E. Epileptic seizures resulting from acute cerebral anoxia. J Neurol Neurosurg Psychiatry 1970; 33: 381–386.CrossRefGoogle ScholarPubMed
31.Synder, BD, Hauser, WA, Loewenson, RB, et al. Neurological prognosis after cardiopulmonary arrest: III. Seizure activity. Neurology 1980; 30: 1292–1297.CrossRefGoogle Scholar
32.Avrahami, E, Drory, VE, Rabey, MJ, et al. Generalized epileptic seizures as the presenting symptom of lacunar infarction in the brain. J Neurol 1988; 235: 472–474.CrossRefGoogle ScholarPubMed
33.Thompson, CB, June, CH, Sullivan, DM, et al. Association between Cyclosporin neurotoxicity and hypomagnesemia. Lancet 1984; 289: 1116–1120.CrossRefGoogle Scholar
34.Shah, D, Rylance, PB, Rogerson, ME, et al. Generalized epileptic fits in renal transplant recipients given Cyclosporin A. Br Med J 1984; 289: 1347–1348.CrossRefGoogle ScholarPubMed
35.Berden, JHM, Hoitsma, AJ, Merx, JL, et al. Severe central-nervous-system toxicity associated with cyclosporin. Lancet 1985; 1: 219–220.CrossRefGoogle ScholarPubMed
36.Boon, AP, Adams, DH, Carey, MP, et al. Cyclosporin-associated cerebral lesions in liver transplantation. Lancet 1988; 1: 1457.CrossRefGoogle ScholarPubMed
37.Deierhoi, MH, Kalayoglu, M, Sollinger, HW, et al. Cyclosporine neurotoxicity in liver transplant recipients: report of three cases. Transplant Proc 1988; 20: 116–118.Google ScholarPubMed
38.Breuer, AC, Blank, NK, Schoene, WC. Multifocal pontine lesions in cancer patients treated with chemotherapy and CNS radiotherapy. Cancer 1978; 41: 2112–2120.3.0.CO;2-W>CrossRefGoogle ScholarPubMed
39.Burger, PC, Kamenar, E, Schold, SC, et al. Encephalomyelopathy following high-dose BCNU therapy. Cancer 1981; 48: 1318–1327.3.0.CO;2-R>CrossRefGoogle Scholar
40.Ang, LC, Heathcote, JG, Gilbert, JJ. Multifocal pontine leukoencephalopathy. A clinicopathologic study of 3 cases. J Neuropathol Exp Neurol 1986; 45: 350(abstr). CrossRefGoogle Scholar
41.Mah, V, Nelson, L, Vinters, HV. Focal pontine leukoencephalopathy in a patient with Schwachman-Diamond Syndrome. Can J Neurol Sci 1987; 14: 608–610.Google Scholar
42.Vinters, HV, Anders, KH, Barach, P. Focal pontine leukoencephalopathy in immunosuppressed patients. Arch Pathol Lab Med 1978; 111: 192–196.Google Scholar
43.Moskowitz, LB, Gregorios, JB, Hensley, GT, et al. Cytomegalovirus induced demyelination associated with acquired immunedeficiency syndrome. Arch Pathol Lab Med 1984; 108: 873–877.Google Scholar
44.Martinez, AJ, Puglia, J. The neuropathology of liver, heart and heart-lung transplantation. Transplant Proc 1988; 20: 806–809.Google ScholarPubMed
45.Oyer, PE, Stinson, EB, Jamieson, SW, et al. Cyclosporine in cardiac transplantation: a 2½ year follow-up. Transplant Proc 1983; 15: 2546–2552.Google Scholar
46.Wallwork, J, Cory-Pearce, R, English, TA. Cyclosporine for cardiac transplantation: the United Kingdom trial. Transplant Proc 1983; 15: 2559–2566.Google Scholar
47.Lanza, RP, Cooper, DKC, Cassidy, MJD, et al. Malignant neoplasms occurring after cardiac transplantation. JAMA 1983; 249: 1746–1748.CrossRefGoogle ScholarPubMed
48.Thiru, S, Calne, RY, Nagington, J. Lymphoma in renal allograft patients treated with Cyclosporin A as one of the immunosuppressive agents. Transplant Proc 1981; 13: 359–364.Google ScholarPubMed
49.Nagington, J, Gray, J. Cyclosporin A in immunosuppressive, Epstein-Barr antibody and lymphoma. (Letter). Lancet 1980; 1: 536–537.CrossRefGoogle ScholarPubMed
50.Crawford, UH, Thomas, JA, Janossy, G, et al. Epstein-Barr virus under antigen positive lymphoma after Cyclosporin A treatment in patient with renal allograft. (Letter). Lancet 1980; 1: 1355–1356.CrossRefGoogle Scholar
51.Penn, I. Cancers following Cyclosporine therapy. Transplantation 1987; 43: 32–35.CrossRefGoogle ScholarPubMed