Intellectual and academic outcomes after pediatric liver transplantation: Relationship with transplant-related factors

Abstract

As survival rates for pediatric liver transplant continue to increase, research attention is turning toward long-term functional consequences, with particular interest in whether medical and transplant-related factors are implicated in neurocognitive outcomes. The relative importance of different factors is unclear, due to a lack of methodological uniformity, inclusion of differing primary diagnoses, varying transplant policies, and organ availability in different jurisdictions. This cross-sectional, single-site study sought to address various methodological limitations in the literature and the paucity of studies conducted outside of North America and Western Europe by examining the intellectual and academic outcomes of Australian pediatric liver transplant recipients (N = 40). Participants displayed significantly poorer intellectual and mathematical abilities compared with the normative population. Greater time on the transplant waitlist was a significant predictor of poorer verbal intelligence, working memory, mathematical abilities, and reading but only when considering the subgroup of children with biliary atresia. These findings support reducing the time children wait for a transplant as a priority.

Kindergarten‐age neurocognitive, functional, and quality‐of‐life outcomes after liver transplantation at under 6 years of age

“…The SPLIT longitudinal study found that FSIQ was 71‐85 in 29% of those assessed and <70 in 7% . Afshar et al in an Australian cohort of 40 patients assessed at age 6‐16 years found FSIQ of 70‐84 in 25% and of <70 in 7.5% . For VMI and GAC, the average scores in our study were more than one‐half SD of population norms, suggesting that as a group, these children have difficulties.…”

“…Third, we were unable to confirm previous studies that have suggested various but inconsistent predictors of outcomes. 4…”

“…Reports in the literature have been limited by non-uniform ages at transplantation and at follow-up assessment, high losses to follow-up, retrospective designs, and small mostly single-center samples. [4][5][6][7][8][9][10][11][12][13][14][15] In addition, some studies used non-independent samples. [9][10][11][12] For example, the recent report from the Studies of Pediatric Liver Transplantation research group and functional outcomes group included 93/546 (17%) of eligible patients (93/144 (65%) of patients that had been tested at an earlier time point).…”

“…[4][5][6][7][8][9][10][11][12][13][14][15][16] Despite these limitations, there were some common findings. Intelligence quotient outcomes often were, on average, within 1 SD of the normative mean [4][5][6][7][8][9][10][11][12]15 ; however, scores were shifted to the left with more survivors than expected having scores below 1 and 2 SD of the normative mean. 4,15,17 HRQL outcomes often were lower than in healthy controls and comparable to those of children with other chronic diseases.…”

“…Intelligence quotient outcomes often were, on average, within 1 SD of the normative mean [4][5][6][7][8][9][10][11][12]15 ; however, scores were shifted to the left with more survivors than expected having scores below 1 and 2 SD of the normative mean. 4,15,17 HRQL outcomes often were lower than in healthy controls and comparable to those of children with other chronic diseases. 16,18 We previously reported neurocognitive outcomes at kindergarten entry in 33 children who had liver transplant at age under 3 years at our center.…”