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Published on: August 29, 2025
Assessment of psychoeducational outcomes after pediatric liver transplant
S Gilmour1, R Adkins, G A Liddell
1Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada. sgilmour@capitalhealth.ca
Insights
Pediatric liver transplant recipients often experience cognitive delays. This study found that pretransplant growth issues and calcineurin inhibitor levels impact intelligence quotient (IQ) in these children.
Area of Science:
- Pediatric Gastroenterology
- Neuroscience
- Transplant Surgery
Background:
- Outcomes research in pediatric liver transplant (LT) traditionally emphasizes mortality and morbidity.
- There is a critical need to evaluate functional outcomes, specifically cognitive development, in pediatric LT survivors.
Purpose of the Study:
- To assess cognitive function in children following liver transplantation for infantile chronic liver disease.
- To identify patient variables associated with cognitive delay or borderline delay post-LT.
Main Methods:
- Administered standardized cognitive testing (Bayley Scales or Wechsler) to 30 transplanted children.
- Analyzed patient variables using multiple regression to determine associations with cognitive scores.
- Examined relationships between pretransplant factors, medication levels, and cognitive outcomes (VIQ/PIQ).
Main Results:
- Mean developmental quotient/intelligence quotient (DQ/IQ) was 81 +/- 17.
- 27% of children showed cognitive delay (DQ/IQ < 70) and 27% borderline delay (DQ/IQ 70-84).
- Pretransplant growth retardation and elevated calcineurin inhibitor levels were associated with decreased IQ; elevated ammonia correlated with lower Performance IQ.
Conclusions:
- Children post-liver transplant are at significant risk for cognitive delay or borderline delay.
- This study is the first to link calcineurin inhibitors to impaired IQ in pediatric LT recipients.
- Different variables predict impaired verbal versus performance intelligence quotients, highlighting distinct neurodevelopmental impacts.
Abstract:
Outcomes research in pediatric liver transplant (LT) has focused on mortality and morbidity but there is a need to also evaluate functional outcomes. Standardized cognitive testing was administered to a cohort of children with infantile chronic liver disease who were transplanted at the University of Alberta during their preschool years. Thirty children had comprehensive assessments with the Bayley Scales of Infant Development or Wechsler testing. Patient variables potentially associated with cognitive delay were analyzed with multiple regression analysis. The mean DQ/IQ score (developmental quotient/intelligence quotient) was 81 +/- 17. Delay (DQ/IQ score < 70), and borderline delay (DQ/IQ 70-84) were each present in 27% of the cohort, with only 46% demonstrating normal cognition. Regression analysis demonstrated that the decreased IQ was associated with pretransplant growth retardation and elevated calcineurin inhibitor levels. Performance IQ had strong correlation with pretransplant growth retardation and elevated serum ammonia, R(2)= 45%, compared to verbal IQ that was associated was elevated calcineurin inhibitor levels, R(2)= 23%. Children post-LT are at high risk for cognitive delay or borderline delay. This is the first study to demonstrate the association calcineurin inhibitors with impaired IQ and also the unique finding of different variables predictive of impaired verbal intelligence quotient (VIQ) versus performance intelligence quotient (PIQ).
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