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Mental and motor development, social competence, and growth one year after successful pediatric liver transplantation
S M Stewart1, R Uauy, D A Waller
1Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas.
Insights
Liver transplantation improved social competence in older children and physical growth, but did not significantly enhance intellectual or motor function. Early-onset liver disease predicted continued developmental delays post-transplant.
Area of Science:
- Pediatric Gastroenterology
- Developmental Pediatrics
- Transplantation Medicine
Background:
- Liver disease can impact neurodevelopment and growth in children.
- Liver transplantation is a life-saving intervention, but its effects on long-term development require evaluation.
Purpose of the Study:
- To assess the impact of liver transplantation on intellectual function, motor skills, social competence, and physical growth in pediatric patients.
- To identify factors influencing post-transplant developmental outcomes.
Main Methods:
- Longitudinal study of 29 children (mean age 4y 7m) before and 1 year after liver transplantation.
- Utilized age-appropriate standardized tests (Bayley Scales, Stanford-Binet, Wechsler Scales, MCDI, Child Behavior Checklist) for cognitive, motor, and social assessments.
- Measured anthropometric parameters (weight, height, head circumference, arm measurements) relative to age and sex norms.
Main Results:
- No statistically significant improvements in intellectual or motor scores for the overall group or those with pre-transplant deficits.
- Children with early-onset liver disease (first year of life) showed a higher likelihood of persistent developmental delays.
- Significant improvements in social competence observed in older children (p < 0.008).
- Significant gains in weight, head circumference, and arm anthropometrics (p < 0.0001–0.04), but no change in linear growth rate.
- Linear growth correlated negatively with steroid dosage; head circumference changes associated with age at transplantation.
Conclusions:
- Liver transplantation significantly improves physical growth and social competence in older children, but neurodevelopmental gains are limited.
- Early-onset liver disease poses a risk for ongoing developmental challenges post-transplantation.
- Steroid dosage and age at transplantation are potential factors influencing post-transplant outcomes.
Abstract:
We measured intellectual and motor function, social competence, and growth in 29 children (mean age 4 years 7 months) before liver transplantation and 1 year later. We used either the Bayley Scales, the Stanford-Binet Intelligence Scale, and the Minnesota Child Development Inventory (MCDI), Motor Age Quotient, or the Wechsler Scales, depending on the age of the child at testing. Social function was measured with the MCDI or the Child Behavior Checklist. All anthropometric measures were expressed relative to normal values for age and sex. Patients whose intellectual and motor scores were less than 80 before transplantation gained an average of 8 points, but these changes were not statistically significant, nor were the changes on these measures for the group as a whole. The development of children with onset of liver disease in the first year of life was more likely to remain delayed after transplantation. Older subjects improved significantly in social competence (p less than 0.008). There were significant increments after transplantation in weight, head circumference, and arm anthropometrics (p less than 0.0001 to 0.04), but there was no change in linear growth rate. Increments in length correlated negatively with steroid dosage, and change in head circumference was associated with age at time of transplantation (p less than 0.005 to 0.10).