*Purpose: Heart transplantation (HT) is considered the gold-standard treatment for end-stage heart failure. In spite of its innumerous benefits, this therapy still involves complications. Among them, neurological complications may impact significantly patient’s morbidity and mortality.Purpose: Determine the prevalence, prognosis and predictors of neurological complications after HT.

*Methods: Between January 2007 to december 2017 data from all patients who underwent orthotopic HT in a single center were collected and analyzed considering seizures, ischemic and hemorrhagic stroke as neurological complications. Univariate and multivariate analysis were performed to determine significant predictors. Furthermore, we also generated ROC curves to determine the value of quantitative variables that could influence the presence of neurological complications.

*Results: We assessed 132 patients from 15 to 76 years of age, mean age of 51.8, (73.5% men). The majority of the patients were in INTERMACS profile 3 (78.8%). Main etiologies included Chagas disease in 26.7%, ischemic cardiomyopathy in 26.7%, idiopathic dilated cardiomyopathy in 24.4% and other etiologies, 22.2%. Neurological events before transplant were present in 16.7%. The prevalence of neurological complications after HT was 17.4% (8.7% ischemic stroke, 60.9% hemorrhagic stroke and 30.4% seizures), and occurred mainly in the first 10 postoperative days (71.4%). In addition to those analyses, we were able to conclude that patients with neurological complications after HT did not present higher mortality risk (p=0.159). In a 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 (determined between mean systolic blood pressure before HT and on the 3rd postoperative day) increased the risk of neurologic complications (64.3% sensitivity, 63% specificity; area under the curve 0.652).

*Conclusions: In this single center study, prevalence of neurological complications was high, however without impact on prognosis. Pre transplant adrenaline use and systolic blood pressure elevation in the 3rd postoperative day in comparison to pre transplant period were predictors of neurological complications.

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