Long‐term Effects of Cholestatic Liver Disease in Childhood on Neuropsychological Outcomes and Neurochemistry

Talcott, Joel B.; Beath, S. V.; Patel, Tulpesh; Griffiths, Gareth; Kelly, Déirdre

doi:10.1097/mpg.0000000000002380

Cited by 24 publications

(36 citation statements)

References 30 publications

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“…LT does not correct the impairment (79,80). In addition, overall health related quality of life is inferior, and prevalence of mental health problems, in particular in adolescents and young adults is higher compared to the general population (81,82).…”

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confidence: 98%

Unacceptable failures: the final report of the Lancet Commission into liver disease in the UK

et al. 2020

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This final report of the Lancet Commission into Liver Disease in the UK stresses the continuing increase in disease burden of liver disease from excess alcohol consumption and obesity, with high levels of hospital admissions and a worsening in deprived areas. It concludes that only with comprehensive food and alcohol strategies based on fiscal and regulatory measures including the Minimum Unit Price (MUP) for alcohol and the alcohol duty escalator, as well as an extension of the sugar levy on food content which has been proven by previous experience in this country, can the disease burden be curtailed. Further evidence of the value of MUP is shown by initial published results (1) of its introduction in Scotland showing an overall 3% reduction in consumption, with the major effect as predicted on heavy drinkers of low-cost alcohol products The major contribution of obesity and alcohol to the high rates of the ten most common cancers is also discussed. The measures outlined by the departing Chief Medical Officer, Dame Sally Davies, to combat rising levels of obesitythe highest of any country in the Westare described along with the estimated health costs. The latest audit analysis of unacceptable levels of mortality for severely ill patients with liver disease in District General Hospitals (DGHs)(2) indicates the need for developing a masterplan for improving hospital care and such a plan is proposed in this report based around specialist hospital centres linked to DGHs by Operational Delivery Networks (ODNs). It has received strong backing from the British Association for Study of the Liver (BASL) and British Society of Gastroenterology (BSG) but is held up at NHS England (NHSE). The value of day-case care bundles to reduce high hospital readmission rates with greater care in the community is described, along with examples of locally derived schemes for the early detection of disease and in particular schemes to allow general practitioners (GPs) to refer patients directly for elastography assessment. New funding arrangements for GPs will be required if these are to be taken up more widely around the country, as is recommended. A new ComRes poll, to be published in autumn 2019, shows an appalling lack of understanding of harm to health from lifestyle causes, with a poor knowledge of alcohol consumption and dietary guidelines. The Commission has serious doubts as to whether the initiatives described in the Prevention Green Paper(3), with the onus placed on the individual based on the use of information technology and the latest in behavioural science will be effective. The final section of the report raises questions of meaningful survival in paediatric liver disease where despite excellent overall survival results, there are high levels of cognitive impairment. In the Conclusion, a strong plea is made for greater coordination between the various official and non-official bodies that have expressed views on the unacceptable disease burden from liver disease in this country in presenting a single, strong voice to the ...

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confidence: 98%

Unacceptable failures: the final report of the Lancet Commission into liver disease in the UK

et al. 2020

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“…[35] Previous research showed a correlation between cholestasis and impaired cognitive outcomes. [36,37] Cholestasis might cause brain lesions, especially in the white matter, which is believed to be the neural foundation for general intelligence. [38] Recently, Talcott et al showed alterations in the brain biochemistry of children with liver disease, including children with asymptomatic liver disease.…”

Section: Discussionmentioning

confidence: 99%

“…[38] Recently, Talcott et al showed alterations in the brain biochemistry of children with liver disease, including children with asymptomatic liver disease. [37] All children with BA are faced with cholestasis prior to KPE surgery, and many also after KPE, making this a possible cause for neurodevelopmental impairments. Major surgery in young children itself may also be a possible risk factor for impaired neurodevelopment.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Neurodevelopmental Outcomes in Children with Biliary Atresia

Rodijk

Heijer

Hulscher

et al. 2020

The Journal of Pediatrics

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To assess long-term neurodevelopmental outcomes in school-aged children with biliary atresia (BA). Study designAll Dutch children (6-12y), diagnosed with BA, were invited to participate in this study. We used validated neurodevelopmental tests to assess motor skills and cognition, and questionnaires to assess behavior. Scores were compared to age-and gender-matched Dutch norms, by means of one-sample tests. Results are given as number and percentages, or mean ± standard deviation. ResultsWe included 46 children, with a median age of 11 years (6-13y). Thirty-six children had undergone a liver transplantation (LTx; 78%). Twelve children (26%) received special education (vs 2.4% in the norm population; p<0.01). Motor outcomes were significantly affected compared to the norm population (p<0.01), with 25% normal (vs 85%), 25% borderline (vs 10%) and 50% low scores (vs 5%). Total IQ was lower in BA patients, compared to the norm population (91±18 vs 100±15; p<0.01). There were no significant differences in test scores between children with native liver and post-LTx. ConclusionsSchool-aged children with BA show neurodevelopmental impairments compared to the norm population, especially in motor skills. Our data strongly warrant evaluation of neurodevelopmental intervention programs to assess whether long-term outcomes could be improved.

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“…It has been noted that children express anxiety regarding medications citing changes to physical appearance and conflict with parents as reasons for non‐adherence 20‐23 . In the current cohort, we found that some of our patients developed depression and/or anxiety related to liver disease and transplantation, which affected their psychological development.…”

Section: Discussionmentioning

confidence: 54%

“…This is comparable to the general population as only It has been noted that children express anxiety regarding medications citing changes to physical appearance and conflict with parents as reasons for non-adherence. [20][21][22][23] In the current cohort, we found that some of our patients developed depression and/or anxiety related to liver disease and transplantation, which affected their psychological development. Although formal quality-of-life questionnaires were not performed, enquiries of survivors identified symptoms consistent with depression and anorexia nervosa either currently or in the past (with some patients having a formal diagnosis consistent with DSM IV criteria for mental health conditions).…”

Section: Discussionmentioning

confidence: 63%

What is the long‐term outlook for young people following liver transplant? A single‐centre retrospective analysis of physical and psychosocial outcomes

Ruth

Sharif²,

Legarda

et al. 2020

Pediatric Transplantation

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LT is a successful treatment for end-stage liver disease. The long-term outcome of patients transplanted in childhood has not previously been widely reported. This project assessed the long-term impact of transplantation in patients surviving >15 years. Retrospective data on growth, end-organ damage and psychosocial development were collected in young people transplanted from 1985 to 2000 in a single centre. Clinical How to cite this article: Ruth N, Sharif K, Legarda M, et al. What is the long-term outlook for young people following liver transplant? A single-centre retrospective analysis of physical and psychosocial outcomes. Pediatr Transplant.

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Long‐term Effects of Cholestatic Liver Disease in Childhood on Neuropsychological Outcomes and Neurochemistry

Cited by 24 publications

References 30 publications

Unacceptable failures: the final report of the Lancet Commission into liver disease in the UK

Unacceptable failures: the final report of the Lancet Commission into liver disease in the UK

Long-Term Neurodevelopmental Outcomes in Children with Biliary Atresia

What is the long‐term outlook for young people following liver transplant? A single‐centre retrospective analysis of physical and psychosocial outcomes

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