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Neurocognitive outcomes after heart transplantation in early childhood
Simon Urschel1, Gwen Y Bond2, Irina A Dinu2
1Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Alberta Transplant Institute, University of Alberta, Edmonton, Alberta, Canada; Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada.
Insights
Children undergoing heart transplantation (HTx) for congenital heart disease (CHD) have lower neurocognitive scores than those with cardiomyopathy (CMP). Pre-transplant factors like kidney injury and intensive care duration predict these outcomes.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Pediatrics
- Transplantation Medicine
Background:
- Children undergoing heart transplantation (HTx) present unique pre-transplant challenges based on underlying conditions: congenital heart disease (CHD) or cardiomyopathy (CMP).
- Understanding neurocognitive differences and predictive factors is crucial for optimizing outcomes in this vulnerable population.
Purpose of the Study:
- To compare neurocognitive capabilities in preschool-aged children undergoing HTx for CHD versus CMP.
- To identify pre-transplant factors that predict neurocognitive outcomes in children receiving HTx.
Main Methods:
- Prospective data collection from children (≤4 years) undergoing HTx (1999-2011).
- Neurocognitive assessment at 54 ± 3 months using Wechsler Preschool and Primary Scales of Intelligence (IQ) and Beery-Buktenica Developmental Test (VMI).
- Prospective collection of pre-transplant factors including medical history, laboratory values, and socioeconomic status.
Main Results:
- Children with CHD (n=32) experienced more complex pre-transplant courses (surgeries, ICU stay, CPB time) than CMP patients (n=23).
- Mean IQ scores were below population norms, significantly lower in the CHD group, with higher intellectual disability rates (FSIQ <70).
- Lower FSIQ and VMI were independently associated with higher pre-HTx creatinine, lactate, longer ICU stays, and lower socioeconomic status.
Conclusions:
- Post-HTx children exhibit borderline to low-average IQ and VMI, with CHD patients scoring significantly lower.
- Difficult pre- and peri-transplant courses correlate with poorer neurocognitive outcomes.
- Early detection and intervention are vital for children post-HTx, particularly those with CHD, necessitating careful follow-up.
Background:
Children requiring heart transplantation (HTx) for congenital heart disease (CHD) or failing anatomically normal hearts (CMP) face different challenges pre-HTx. We compared the neurocognitive capabilities in pre-school-age children receiving HTx for CHD vs CMP and determined factors predicting outcomes.
Methods:
Data were collected within a prospective multi-provincial project from children who underwent HTx ≤4 years of age between 1999 and 2011. At age 54 ± 3 months, we obtained scores from the Wechsler Preschool and Primary Scales of Intelligence for full-scale intelligence quotient (FSIQ) verbal intelligence quotient (VIQ) and performance intelligence quotient (PIQ), and from the Beery-Buktenica Developmental Test for visual-motor integration (VMI). Possible predictive factors were collected prospectively from transplant listing.
Results:
Of the 76 patients included in the study, 61 survived to assessment, 2 were lost to follow-up and 4 were excluded for genetic disorders or heart-lung transplant. The CHD patients (n = 32) had significantly more previous surgeries, more severe kidney injuries, more days on ventilator and in intensive care, broader human leukocyte antigen (HLA) sensitization, longer cardipulmonary bypass (CPB) times and higher inotropic scores than CMP patients (n = 23). Mean IQ scores for the HTx children were below population norms and significantly lower in children with CHD. Intellectual disability (FSIQ <70) was more common in the CHD group (p = 0.036). The lower VMI in CHD patients approached significance. Lower FSIQ and VMI were independently associated with higher pre-HTx creatinine and lactate, longer stay in intensive care and lower socioeconomic status.
Conclusions:
Children post-HTx showed IQ and VMI scores within the borderline to low-average range, with CHD children ranging significantly lower. Low scores are associated with a more difficult pre- and peri-transplant course. Careful follow-up is required to warrant early detection of deficits and introduction of interventions and supportive measures.
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