Attention and Executive Functioning Deficits in Liver-Transplanted Children

Abstract

Liver-transplanted children have an increased risk for serious developmental problems. We examined attention and executive functioning and their relation to intelligence and several disease-related variables after transplantation. This is a monocentric, cross-sectional study with no reference group. Children's mean age at transplantation was 3.4+/-3.8 years (n=137, age 10.2+/-3.8 years). Assessment included attention and executive functioning (Test of Attentional Performance [TAP]/Test of Attentional Performance [children's version] [KITAP]) and intelligence (Wechsler Intelligence Scale for Children, 3rd edition/Kaufman Assessment Battery for Children). In most TAP and KITAP Subscales, children scored in the lower normal range, but reaction times, errors, and omissions were significantly below the population mean. Most notable deficits became manifest in the subscales Sustained Attention and Working Memory where 47% respectively 38% of the present sample scored below the normal range. Most TAP and KITAP Subscales, particularly Alertness and Go/NoGo, were highly correlated with Wechsler Intelligence Scale for Children, 3rd edition and Kaufman Assessment Battery for Children Subscales indicating that liver-transplanted children with longer reaction times display lower intelligence scores. Regression analysis revealed that decelerated reaction times in the subscales TAP-Go/NoGo, Divided Attention (KITAP and TAP), and KITAP-Sustained Attention were associated with type of donation, duration of disease, age at transplantation, and sex (R²=0.14 to R²=0.25). Results provide evidence suggesting that liver-transplanted children are at risk of developmental deficits regarding attention and executive functioning. Especially intrinsic alertness and working memory performance seem to be insufficient. This might result in deficient initiating, sustaining, and controlling of action. In summary, results demonstrate the need for an early and comprehensive developmental screening after pediatric liver transplantation.