Neurocognitive functioning after heart transplantation

Neuropsychological functioning of patients undergoing evaluation for heart transplantation has been described in seven reports in the literature, two of which have described neuropsychological functioning after transplantation. The purpose of this study was to examine the changes in neurocognitive function after heart transplantation, to determine if medical variables predict neuropsychological outcome, and to determine if pre-operative neuropsychological differences exist between patients who do and do not survive at least one year after transplantation.

Patients undergoing heart transplantation evaluation were administered a neuropsychological test battery. Twelve to 19 months after transplantation, 27 patients survived and were re-evaluated.

A pre-post design was used to determine whether neuropsychological functioning changed after transplantation in a group of 25 patients. Analyses indicated improvement in higher-level cognitive functioning. Patients who were not as sick at transplantation (status two) evidenced improvement in confrontational naming. In addition, the need for neurosurgery after transplantation significantly predicted neuropsychological outcome. Level of education, pre-operative cardiac index, pre-operative pulmonary capillary wedge pressure, and number of rejections after transplantation were significantly associated with neuropsychological outcome. There were no significant differences in pre-operative neuropsychological functioning between these two groups.

The results of this study suggested that heart transplantation does not have a negative effect on post-operative neuropsychological functioning. A small improvement was seen in mental speed and cognitive efficiency after transplantation. Pre-operative neuropsychological functioning did not predict gross outcome (survival at one year), although there was a relationship between pre-operative and post-operative health and neuropsychological outcome.