Cognitive Function Post Liver Transplant

Abstract

Research Article| October 01 2014 Cognitive Function Post Liver Transplant AAP Grand Rounds (2014) 32 (4): 45. https://doi.org/10.1542/gr.32-4-45 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Cognitive Function Post Liver Transplant. AAP Grand Rounds October 2014; 32 (4): 45. https://doi.org/10.1542/gr.32-4-45 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: cognitive ability, liver transplantation Source: Sorenson LG, Neighbors K, Martz K, et al. Longitudinal study of cognitive and academic outcomes after pediatric liver transplantation. J Pediatr. 2014; 165(1): 65– 72.e2; doi: https://doi.org/10.1016/j.jpeds.2014.03.032Google Scholar Investigators from the Functional Outcomes Group (FOG), which includes 20 pediatric liver transplant centers in the Studies of Pediatric Liver Transplantation (SPLIT) collaborative, sought to determine the evolution of cognitive and academic deficits in children after liver transplant. Study children were identified and recruited through the SPLIT registry, and were 5–6 years of age when enrolled and ≥2 years posttransplant. Cognitive performance was measured at enrollment (Time 1) and repeated when participants were 7–9 years old (Time 2). Patients were tested with the Wechsler Preschool and Primary Scale of Intelligence (WPPSI), 3rd edition, at Time 1 and the Wechsler Intelligence Scales for Children (WISC), 4th edition, at Time 2. Composite scores were generated for each including Full Scale IQ (FSIQ), Verbal IQ/Verbal Comprehension (VC), Performance IQ/Perceptual Reasoning (PR), and Processing Speed (PS); a Working Memory (WM) composite score was also generated for the WISC-IV. These scores have a mean of 100 and SD of 15 in the normal population. At both time points, the participants also completed the Wide Range Achievement Test, 4th edition, Word Reading and Math Computation subtests and parents and teachers completed the Behavior Rating Inventory of Executive Function (BRIEF). Medical and demographic variables were also collected to determine which predicted cognitive performance. One hundred forty-four patients were tested at Time 1, and 93 (65%) at Time 2. At Time 2, more patients had below-average FSIQ, VC, WM, and Math Computation compared to these scores’ normal distribution. For FSIQ specifically, 29% had scores of 71–85, and 7% had scores ≤70, both of which were significantly different than a normative population (P = .0001). BRIEF scores were also significantly lower than a normative population, but no different than at Time 1. A total of 42% of participants received special education. Identified risk factors for lower FSIQ included one-person household (P < .002), parental education level of some high school or less (P < .01), weight z-score <-2 standard deviations at liver transplantation (P < .03), and intraoperative transfusion requirement (P < .0001). The investigators conclude that, although the majority of children who are post-liver transplant demonstrate average functioning, many have long-term cognitive and academic problems. They report that cognitive outcomes may be predicted by pretransplant and peritransplant variables. Drs Kasper and Neimark have disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Children with chronic disease often have cognitive impairments.1,2 Deficits in neurocognitive ability translate into reduced academic achievement, difficult social interactions, and lower quality of life. Identification of risk factors for poor outcomes will help direct limited fiscal resources. There is little scientific literature, however, to delineate long-term consequences of disease... You do not currently have access to this content.