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Neurodevelopmental outcomes of infant multivisceral transplant recipients: a longitudinal study
D M Thevenin1, A Baker, T Kato
1Department of Pediatrics, UMMG Physician-Patient Advocacy Program, University of Miami/Miller School of Medicine, Miami, FL 33101, USA. dthevenin@med.miami.edu
Insights
Most children undergoing intestinal transplants experience ongoing cognitive and physical delays post-surgery. Multivisceral transplants may increase the risk of these developmental delays, highlighting the need for early intervention.
Area of Science:
- Pediatric Gastroenterology
- Developmental Pediatrics
- Transplant Surgery
Background:
- Intestinal transplantation is a life-saving procedure for children with irreversible intestinal failure.
- Post-transplant outcomes require comprehensive assessment, including neurodevelopmental trajectories.
Purpose of the Study:
- To longitudinally evaluate cognitive and physical development in pediatric intestinal transplant recipients.
- To identify risk factors for developmental delays in this population.
Main Methods:
- Longitudinal study involving nine pediatric intestinal transplant recipients (ages 8-29 months at transplant).
- Assessments conducted pre- and post-transplant using the Bayley Scales of Infant Development.
- Classifications included isolated intestine, combined intestine-liver, and multivisceral transplants.
Main Results:
- A majority of children (55.6%) remained significantly delayed in mental development post-transplant.
- 33.3% experienced a decline in mental development classification.
- 78% showed persistent significant motor developmental delays, with 11.1% experiencing new delays.
Conclusions:
- Most pediatric intestinal transplant recipients continue to exhibit developmental delays at discharge.
- Multivisceral transplants may confer a higher risk for persistent cognitive and physical delays.
- Early neurodevelopmental evaluations and interventions are crucial for optimizing outcomes.
Unlabelled:
This longitudinal investigation compares cognitive and physical capabilities of transplant recipients, both before and after receiving an intestinal transplant.
Methods:
Using the Bayley Scales of Infant Development, we conducted pretransplant and posttransplant assessments on nine children (4 males, 5 females) who received either an isolated intestine, combined intestine and liver, or multivisceral transplants, with a mean age at transplant of 18 months (range 8-29) and a mean time posttransplant of 2 months (range 1-4 months).
Results:
Scores on the Mental Developmental Index reflected that a majority (55.6%) of patients who scored in the significantly delayed range prior to transplant remained in the significantly delayed classification after receiving a transplant. In addition, 33.3% showed a decrease in their mental classification; either from "mildly delayed" to "significantly delayed" or from "within normal limits" to "mildly delayed". Results on the Motor Developmental Index demonstrated that 78% of recipients had significant delays both before and after receiving a transplant, while 11.1% fell one standard deviation after transplantation. We found that the majority of children who experience developmental delays prior to transplant are still experiencing delays when they are discharged from inpatient care. In addition, those children receiving multivisceral transplantations, as opposed to an isolated bowel, may be at a much greater risk of developing and retaining both cognitive and physical delays. Early neurodevelopmental evaluations of these patients is essential for early parental education and compliance with early intervention services to maximize potential recovery and ability to obtain normal development.
