Longitudinal Study of Cognitive and Academic Outcomes after Pediatric Liver Transplantation

Abstract

Objective To determine the evolution of cognitive and academic deficits and risk factors in children after liver transplantation. Study design Patients ≥2 years after liver transplantation were recruited through Studies of Pediatric Liver Transplantation. Participants age 5–6 years at Time 1 completed the Wechsler Preschool and Primary Scale of Intelligence, 3rd edition, Wide Range Achievement Test, 4th edition, and Behavior Rating Inventory of Executive Function (BRIEF). Participants were retested at age 7–9 years, Time 2 (T2), by use of the Wechsler Intelligence Scales for Children, 4th edition, Wide Range Achievement Test, 4th edition, and BRIEF. Medical and demographic variables significant at P ≤ .10 in univariate analysis were fitted to repeated measures modeling predicting Full Scale IQ (FSIQ). Results Of 144 patients tested at time 1, 93 (65%) completed T2; returning patients did not differ on medical or demographic variables. At T2, more participants than expected had below-average FSIQ, Verbal Comprehension, Working Memory, and Math Computation, as well as increased executive deficits on teacher BRIEF. Processing Speed approached significance. At T2, 29% (14% expected) had FSIQ = 71–85, and 7% (2% expected) had FSIQ ≤70 (P = .0001). A total of 42% received special education. Paired comparisons revealed that, over time, cognitive and math deficits persisted; only reading improved. Modeling identified household status (P < .002), parent education (P < .01), weight z-score at liver transplantation (P < .03), and transfusion volume during liver transplantation (P < .0001) as predictors of FSIQ. Conclusions More young liver transplantation recipients than expected are at increased risk for lasting cognitive and academic deficits. Pretransplant markers of nutritional status and operative complications predicted intellectual outcome.

Long-term nutritional and cognitive outcomes after liver transplantation in childhood

“…Our small cohort achieved normal intellect with mean full scale IQ 97, almost at population mean of 100, in contrast to previous reports of low average intelligence, with intellectual impairment in 30-54% of patients 104,105 . Era of transplantation was unlikely to account for this since 85% of our patients were transplanted between 1991 to end of 2000.…”

“…-1.7 105 . Chronic Iiver disease, hepatic encephalopathy, hypotension and cerebral ischaemia, as well as frequency and duration of general anaesthesia are some of the peritransplant factors that may potentially impact neurocognitive development of liver transplant survivors.…”

“…Early steroid discontinuation or steroid free regimes of immunosuppression 105 should be considered to ensure normalization of BMD. Pathological fractures in children however only occurred within the first 18 months of transplant, with no further fractures despite persistently reduced BMD.…”

“…Of concern, a Canadian study reported only 46% of their cohort to have normal IQ with the rest having definite or borderline intellectual impairment 104 . A recent, large, multicenter study in children at least 2 years post transplant was more encouraging; reporting full scale IQ within the normal range, mean 94.7±13.5, but 30% of their cohort had intellectual impairment, and 4% were severely impaired with IQ <70 105 .…”

Updates in Psychosomatic Medicine: 2014

“…The articles were Updates in Psychosomatic Medicine related to 15 subspecialties: cardiac psychiatry, [4][5][6][7][8][9] collaborative care/integrated behavioral health, 10,11 emergency psychiatry, 12,13 HIV psychiatry, [14][15][16][17][18][19][20] neuropsychiatry, 21-31 pediatric psychosomatic medicine, 32-36 psychodermatology, [37][38][39][40][41][42][43][44][45] psychonephrology, 46-55 psycho-oncology and palliative care, [56][57][58][59][60][61][62][63][64] serious mental illness, [65][66][67][68][69][70][71][72] somatic symptom disorders, 73 suicide, 74-78 transplant psychiatry, [79][80][81][82][83][84]…”