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Impact of Immunosuppression on Executive Functioning After Pediatric Liver Transplantation: An Observational Cohort

Imeke Goldschmidt1, Rolf van Dick2, Christoph Jacobi3

  • 1Department of Paediatric Gastroenterology and Hepatology, Hannover Medical School, Hannover.

Journal of Pediatric Gastroenterology and Nutrition
|January 22, 2019
PubMed

Insights

Children

Area of Science:

  • Pediatric medicine
  • Neuroscience
  • Immunology

Background:

  • Liver transplantation in children is linked to impaired cognitive function.
  • Executive functioning deficits are a concern in this population.
  • Understanding factors influencing cognitive outcomes is crucial for intervention.

Purpose of the Study:

  • To evaluate the impact of immunosuppressive therapy on executive functioning in pediatric liver transplant recipients.
  • To assess executive functioning using the Children's Color Trail Test and PedsQL cognitive module (cogPedsQL).
  • To identify potential targets for interventions aimed at enhancing executive function post-transplant.

Main Methods:

  • Cross-sectional study of 155 children (aged 2-18) post-liver transplant.
  • Executive functioning assessed via Children's Color Trail Test and parent/patient cogPedsQL.
  • Comparison of outcomes between different calcineurin inhibitor (CNI) regimens, including a switch to once-daily slow-release tacrolimus (Tac).

Main Results:

  • Worse executive functioning correlated with longer ICU stays and time since transplant.
  • No significant difference between cyclosporine and tacrolimus users.
  • Children on once-daily slow-release tacrolimus showed better performance than those on twice-daily tacrolimus.
  • Parent-proxy cogPedsQL improved significantly in children switching to once-daily tacrolimus.

Conclusions:

  • Executive functioning may deteriorate over time post-liver transplant, influenced by disease burden.
  • Once-daily slow-release tacrolimus may offer advantages over twice-daily administration for executive function.
  • Further research is needed to optimize immunosuppressive strategies for cognitive health in pediatric liver transplant survivors.
Abstract

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