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Published on: February 10, 2018
Impaired motor competence in children with transplanted liver
Runar Almaas1, Unn Jensen, Marianne C Loennecken
1*Department of Pediatric Research, Rikshospitalet, Oslo University Hospital †Institute of Health and Society, Medical Faculty, University of Oslo ‡Section for Transplantation Surgery, Department of Transplantation Medicine §Division of Surgery and Clinical Neuroscience, Department of Orthopaedics, Section of Research, Oslo University Hospital, Oslo, Norway.
Insights
Children undergoing liver transplantation show impaired motor skills, including ball skills and balance, compared to healthy peers. These deficits persist and do not improve over time post-transplant.
Area of Science:
- Pediatric medicine
- Transplantation surgery
- Motor development
Background:
- Cognitive function deficits are known after pediatric liver transplantation.
- Limited data exist on motor competence in this population.
Purpose of the Study:
- To assess motor competence in children after liver transplantation.
- To compare their motor skills with healthy children.
Main Methods:
- Movement Assessment Battery for Children (M-ABC) test administered to 35 children (4-12 years) post-liver transplant.
- Comparison with a healthy reference group.
Main Results:
- Children with liver transplants exhibited significantly worse M-ABC scores (P < 0.0001).
- Impaired manual dexterity, ball skills, and balance were observed.
- 29% of transplanted children had impaired motor competence versus 9% of controls.
- Motor competence did not improve over time; ball skills worsened 4 years post-transplant.
- Renal function predicted motor competence in children with cholestatic liver disease.
Conclusions:
- Liver transplantation in children is associated with impaired motor competence.
- Adverse development in ball skills occurs years after transplantation.
- Motor skills do not improve post-transplant, with some areas declining.
- Renal function is a key predictor of motor outcomes in specific pediatric liver transplant subgroups.
Objectives:
Although reduced cognitive function has been demonstrated after liver transplantation in children, few data are available concerning motor competence.
Methods:
Thirty-five children ages 4 to 12 years were tested using Movement Assessment Battery for Children (M-ABC) test at a median of 5.1 (3.9-6.9) years after liver transplantation and compared with reference material of healthy children.
Results:
Children with transplantation had worse M-ABC score 8.0 (interquartile range 5.0-11.5), compared with healthy children 3.5 (1.0-6.0) (P < 0.0001). All of the subscores (manual dexterity [P < 0.0001], ball skills [P = 0.0037], and balance [P = 0.0032]) were significantly worse in the children with liver transplantation compared with the healthy reference group. Twenty-nine percent of the children with liver transplantation had impaired motor competence, compared with 9% of a healthy reference group. Seventeen of the patients with transplantation were retested 1 year later, and 11 were tested 4 years later with no changes in total M-ABC score. Ball skill competence was worse 4 years after first assessment (P = 0.013). For children with transplantation and cholestatic liver disease (n =26), renal function was a significant predictor for total M-ABC score (P = 0.018).
Conclusions:
Children with liver transplantation had impaired motor competence compared with healthy children. Ball skills developed adversely several years after liver transplantation, and motor competence did not improve with time after transplantation. Renal function was a significant predictor for motor competence in children with liver transplantation and cholestatic liver disease.
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