Cognitive and academic outcomes after pediatric liver transplantation: Functional Outcomes Group (FOG) results
L G Sorensen1, K Neighbors, K Martz
1Child and Adolescent Psychiatry, Children's Memorial Hospital, Chicago, IL, USA. Lsorensen@childrensmemorial.org
Insights
Children who received a liver transplant (LT) show higher rates of cognitive and academic delays. These findings highlight the need for ongoing developmental monitoring in pediatric LT survivors.
Area of Science:
- Pediatric Medicine
- Neuroscience
- Transplant Surgery
Background:
- Liver transplantation (LT) is a life-saving procedure for children with end-stage liver disease.
- Long-term neurodevelopmental outcomes following pediatric LT require further investigation.
Purpose of the Study:
- To determine the prevalence of cognitive and academic delays in children 5-7 years old, 2 years post-liver transplant (LT).
- To assess executive function deficits in pediatric LT recipients.
Main Methods:
- A multicenter study involving 144 pediatric LT recipients (ages 5-7, ≥2 years post-LT).
- Standardized assessments included Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III), Bracken Basic Concept Scale (BBCS-R), and Wide Range Achievement Test (WRAT-4).
- Executive function evaluated using the Behavior Rating Inventory of Executive Function (BRIEF); parent and teacher reports collected.
Main Results:
- Participants demonstrated significantly lower scores than population norms in intelligence quotient (IQ) and academic achievement (Reading, Math).
- Prevalence of mild-to-moderate (26%) and serious (4%) IQ delays were significantly higher than expected.
- Learning disabilities (reading/math scores weaker than IQ) were identified in 25% of patients, compared to 7% expected.
- Executive deficits were prevalent, particularly noted by teachers.
Conclusions:
- Pediatric LT recipients exhibit a higher prevalence of cognitive, academic, and executive function delays compared to the general population.
- These findings underscore the importance of comprehensive neurodevelopmental surveillance in children post-liver transplant.
Abstract:
This multicenter study examined prevalence of cognitive and academic delays in children following liver transplant (LT). One hundred and forty-four patients ages 5-7 and 2 years post-LT were recruited through the SPLIT consortium and administered the Wechsler Preschool and Primary Scale of Intelligence, 3rd Edition (WPPSI-III), the Bracken Basic Concept Scale, Revised (BBCS-R), and the Wide Range Achievement Test, 4th edition (WRAT-4). Parents and teachers completed the Behavior Rating Inventory of Executive Function (BRIEF). Participants performed significantly below test norms on intelligence quotient (IQ) and achievement measures (Mean WPPSI-III Full Scale IQ = 94.7 ± 13.5; WRAT-4 Reading = 92.7 ± 17.2; WRAT-4 Math = 93.1 ± 15.4; p < 0001). Twenty-six percent of patients (14% expected) had 'mild to moderate' IQ delays (Full Scale IQ = 71-85) and 4% (2% expected) had 'serious' delays (Full Scale IQ ≤ 70; p < 0.0001). Reading and/or math scores were weaker than IQ in 25%, suggesting learning disability, compared to 7% expected by CDC statistics (p < 0.0001). Executive deficits were noted on the BRIEF, especially by teacher report (Global Executive Composite = 58; p < 0.001). Results suggest a higher prevalence of cognitive and academic delays and learning problems in pediatric LT recipients compared to the normal population.
