Academic potential and cognitive functioning of long‐term survivors after childhood liver transplantation

Abstract

This cross-sectional study assessed intellect, cognition, academic function, behaviour, and emotional health of long-term survivors after childhood liver transplantation. Eligible children were >5 yr post-transplant, still attending school, and resident in Queensland. Hearing and neurocognitive testing were performed on 13 transplanted children and six siblings including two twin pairs where one was transplanted and the other not. Median age at testing was 13.08 (range 6.52-16.99) yr; time elapsed after transplant 10.89 (range 5.16-16.37) yr; and age at transplant 1.15 (range 0.38-10.00) yr. Mean full-scale IQ was 97 (81-117) for transplanted children and 105 (87-130) for siblings. No difficulties were identified in intellect, cognition, academic function, and memory and learning in transplanted children or their siblings, although both groups had reduced mathematical ability compared with normal. Transplanted patients had difficulties in executive functioning, particularly in self-regulation, planning and organization, problem-solving, and visual scanning. Thirty-one percent (4/13) of transplanted patients, and no siblings, scored in the clinical range for ADHD. Emotional difficulties were noted in transplanted patients but were not different from their siblings. Long-term liver transplant survivors exhibit difficulties in executive function and are more likely to have ADHD despite relatively intact intellect and cognition.

Assessment of School Readiness in Chronic Cholestatic Liver Disease: A Pilot Study Examining Children with and without Liver Transplantation

“…Knowledge of early concepts such as shape, number, and letters fell at or above age expected norms among our cohort, using the Bracken measure which assesses understanding of early concepts, not emergent reading, spelling, or number abilities. Previous studies have reported a 3-fold increase in learning disabilities in pediatric liver transplant [ 4 , 5 ]. This higher prevalence may be associated with the negative impact of visuospatial difficulties on early academic skill acquisition/production.…”

“…In several larger population studies [ 12 , 21 ] evidence of sustained attention, working memory, and behavioural regulation deficits has been reported, less often at home compared to school, following pediatric LT. Greater than 30% of 13-year-old children with transplantation [ 4 ] were diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), which is much higher than general reported prevalence of 5%. Interestingly, none of the siblings in this cohort shared this diagnosis, suggesting a possible acquired (not hereditary) etiology.…”

“…Potential contributory factors include the following: higher levels of school stress due to the need to navigate academic and social demands and managing a chronic medical condition [ 18 ]. The negative impact of chronic illness on the whole family unit [ 4 ] is reported in traumatic brain injury [ 15 ]. Self-report and parent report of health related quality of life in LT and renal transplant [ 18 ] indicate lower overall scores when compared to healthy children [ 19 ], which is similar to our study where the parents of LT children report lower academic, social, and motor competency compared to LD parents.…”

The Effect of Pediatric Living Donor Liver Transplantation on Neurocognitive Outcomes in Children

“…Therefore, the new assessment was carried out 6 months after surgery. On the other hand, many studies have found that long-term neurocognitive development in children after liver transplantation is not ideal, with lower preschool IQ scores [2,24]. The behavioral scoring, such as verbal writing, Wechsler intelligence scores, and even adaptability to society, are not satisfactory [25].…”

Neuropsychomotor Development in Children and Adolescents With Liver Diseases: Systematic Review With Meta-Analysis

“…Ten instruments were used to evaluate the variables of interest. For cognition and executive functions, versions of the Wechsler Intelligence Scales (WISC) were the most used (15/17) (5,9,12,(14)(15)(16)(17)(18)(19)(20)(21)(22) . General, fine and gross motor development were assessed using the following instruments: Movement Assessment Battery for Children (M-ABC) (23) , Mullen Scales of Early Learning (MSEL) (10,24) , Bayley Development Scales (25,26) , Griffiths Mental Ability Scales (GMDS) (27) and General Development Scale of Minnesota Child Development Inventory (MCDI) (15) .…”