Longitudinal Study of Cognitive and Academic Outcomes after Pediatric Liver Transplantation - 25/06/14
, Katie Neighbors, MPH, CCRC 2, Karen Martz, MS 3, Frank Zelko, PhD 1, John C. Bucuvalas, MD 4, Estella M. Alonso, MD 2on behalf of the
Studies of Pediatric Liver Transplantation (SPLIT) Research Group and the Functional Outcomes Group (FOG)∗
Abstract |
Objective |
To determine the evolution of cognitive and academic deficits and risk factors in children after liver transplantation.
Study design |
Patients ≥2 years after liver transplantation were recruited through Studies of Pediatric Liver Transplantation. Participants age 5-6 years at Time 1 completed the Wechsler Preschool and Primary Scale of Intelligence, 3rd edition, Wide Range Achievement Test, 4th edition, and Behavior Rating Inventory of Executive Function (BRIEF). Participants were retested at age 7-9 years, Time 2 (T2), by use of the Wechsler Intelligence Scales for Children, 4th edition, Wide Range Achievement Test, 4th edition, and BRIEF. Medical and demographic variables significant at P ≤ .10 in univariate analysis were fitted to repeated measures modeling predicting Full Scale IQ (FSIQ).
Results |
Of 144 patients tested at time 1, 93 (65%) completed T2; returning patients did not differ on medical or demographic variables. At T2, more participants than expected had below-average FSIQ, Verbal Comprehension, Working Memory, and Math Computation, as well as increased executive deficits on teacher BRIEF. Processing Speed approached significance. At T2, 29% (14% expected) had FSIQ = 71-85, and 7% (2% expected) had FSIQ ≤70 (P = .0001). A total of 42% received special education. Paired comparisons revealed that, over time, cognitive and math deficits persisted; only reading improved. Modeling identified household status (P < .002), parent education (P < .01), weight z-score at liver transplantation (P < .03), and transfusion volume during liver transplantation (P < .0001) as predictors of FSIQ.
Conclusions |
More young liver transplantation recipients than expected are at increased risk for lasting cognitive and academic deficits. Pretransplant markers of nutritional status and operative complications predicted intellectual outcome.
Le texte complet de cet article est disponible en PDF.Keyword : BRI, BRIEF, EF, FOG, FSIQ, GEC, MI, PR, PS, SPLIT, T1, T2, VC, WISC-IV, WM, WPPSI-III, WRAT-4
Plan
| Supported by the National Institute of Child Health and Human Development (R01 HD045694) and the National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK061693). The sponsoring agencies were not involved in the collection, analysis, or interpretation of data or the generation of the report. The authors declare no conflict of interest. |
Vol 165 - N° 1
P. 65 - juillet 2014 Retour au numéro
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