Neurodevelopmental outcome in high‐risk patients after renal transplantation in early childhood

Abstract

Patient and graft survival rates of pediatric renal transplant recipients are currently excellent, but there are few reports regarding the long-term neurodevelopmental outcome after renal transplantation (Tx) in early childhood. Children with renal failure from infancy would be expected to have a less favorable developmental prognosis. We report the neurodevelopmental outcome in 33 school-age children transplanted between 1987 and 1995 when < 5 yr of age. We prospectively performed a neurological examination, magnetic resonance imaging (MRI) of the brain, electroencephalograms (EEGs), audiometry, and neuropsychological tests (NEPSY), and measured cognitive performance (WISC-R); we related these results to school performance and to retrospective risk factors prior to Tx. Twenty-six (79%) children attended normal school and 76% had normal motor performance. Six of the seven children attending a special school had brain infarcts on MRI. The EEG was abnormal in 11 (35%), and five (15%) received anti-convulsive treatment after Tx. Sensorineural hearing loss was documented in six patients. The mean intelligence quotient (IQ) was 87, and 6-24% showed impairment in neuropsychological tests. The children attending a special school had been more premature, but had not had a greater number of pre- or neonatal complications. They had experienced a greater number of hypertensive crises (p = 0.002) and seizures (p = 0.03), mainly during dialysis, but the number of septic infections and the mean serum aluminum levels were not significantly greater than in the children with normal school performance. In these previously lethal diseases, the overall neurodevelopmental outcome is reassuring. However, it is of crucial importance to further minimize the risk factors prior to Tx.

Intellectual and motor performance, quality of life and psychosocial adjustment in children with cystinosis

“…One study that examined motor performance in young children using the Bayley Scales of Infant Development found that motor development was abnormal in 24% of children transplanted in early childhood [41]. Neurological co-morbidity was the most negative predictor of poor motor performance [41]. It has been suggested that mutations in the CTNS gene may influence brain development [42].…”

“…Muscular hypotonia can be associated with poorer motor perfor- mance, in particular with static balance tasks. One study that examined motor performance in young children using the Bayley Scales of Infant Development found that motor development was abnormal in 24% of children transplanted in early childhood [41]. Neurological co-morbidity was the most negative predictor of poor motor performance [41].…”

Tissue Expression of Nephrin in Human and Pig

“…Some NPHS1 patients who received a transplant in infancy have abnormal electroencephalograms and problems in cognitive performance at school age. These, however, are associated with the pretransplantation complications, such as hypertensive crises, seizures, and cerebral infarcts (38). Approximately 80% of NPHS1 children attend normal school.…”

Renal transplantation in infants

“…The mean intelligent quotient (IQ) was 87, and 6-24 % showed impairment in neuropsychological tests. About 80 % of the children attended normal school and 76 % had normal motor performance [86]. In another study, 50 children transplanted at an early age were assessed at a mean age of 11.1 years.…”