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Risk of hearing impairment in pediatric liver transplant recipients: a single center study
John C Bucuvalas1, Amy O'Connor, Kristen Buschle
1Pediatric Liver Care Center, Division of Audiology, Medical Center, Cincinnati Children's Hospital, Cincinnati, OH 45229, USA. john.buc@chmcc.org
Insights
Pediatric liver transplant recipients face a significant risk of hearing loss, particularly those with hepatoblastoma or prolonged hospital stays. Early detection is crucial for language development.
Area of Science:
- Pediatric Medicine
- Otolaryngology
- Transplantation Surgery
Background:
- Liver transplantation survival rates are increasing.
- Hearing impairment can negatively affect child development.
- Ototoxic drug exposure is a potential risk factor for hearing loss in transplant patients.
Purpose of the Study:
- To determine the incidence of hearing impairment in children post-liver transplantation.
- To identify risk factors associated with hearing loss in this population.
Main Methods:
- Retrospective review of 74 pediatric liver transplant recipients.
- Audiological assessment at discharge.
- Analysis of variables including age, diagnosis, hospital stay, and medication exposure.
Main Results:
- 15% of children (11 of 74) developed sensorineural hearing loss.
- Hepatoblastoma diagnosis showed a 66-fold increased risk.
- Each additional day of hospitalization increased hearing loss risk by 5%.
Conclusions:
- Sensorineural hearing impairment is a notable complication in pediatric liver transplant recipients.
- Hepatoblastoma and prolonged hospitalization are significant risk factors.
- Findings are critical given the age of transplant recipients and language development stages.
Abstract:
As survival rates following liver transplantation have increased, health care providers must assess the impact of transplantation on dimensions other than traditional medical measures. Hearing impairment may adversely impact social, emotional, cognitive, academic, and speech and language development. We hypothesized that children who undergo liver transplantation are at risk for hearing impairment due to exposure to ototoxic drugs. We conducted a review of 74 children who had undergone liver transplantation between December 1996 and September 2000 at Cincinnati Children's Hospital Medical Center. Hearing was assessed at discharge by an audiologist using age and developmentally appropriate techniques. The principal outcome measure was sensorineural hearing impairment. Independent variables were age at transplantation, United Network for Organ Sharing (UNOS) status at transplantation, primary diagnosis, post-transplant length of hospital stay, days of treatment with aminoglycosides, and days of treatment with loop diuretics. Eleven of 74 children (15%) had sensorineural hearing loss, of whom four had severe to profound hearing loss. Multivariate analyses showed that the adjusted relative risk for hearing loss in patients with hepatoblastoma was 66 and that there was a 5% increase risk for hearing loss for each additional day of hospitalization. Age at transplantation, UNOS status, and days of treatment with loop diuretics or aminoglycosides did not achieve significance in the model. Sensorineural hearing impairment occurs in a subset of pediatric patients following liver transplantation. Patients with hepatoblastoma or those who experience prolonged hospitalization after transplantation are at increased risk. Our observations are of particular importance for pediatric liver transplant recipients since the median age at transplantation is 12-18 months, a critical period for language acquisition.
