Cognitive Functioning in Children with Biliary Atresia after Liver Transplantation

Abstract

Introduction: Because different primary diseases might bias cognitive functioning outcomes of liver transplanted children, we exclusively examined children with biliary atresia after transplantation (Ltx). We hypothesized that the cognitive performance in children with biliary atresia before Ltx is below the population mean postoperatively. Methods: The sample consisted of 70 liver transplanted children (age at assessment: 8;4±3;5 years, range: 5;0-15;2; age at Ltx: 1;5±2;3 years, range: 0;1-14;8 years). 49% had received a living related donation (LRD). Assessment of cognitive functioning included: Kaufman-Assessment-Battery for Children (K-ABC; 5-7 years, n=27) and Wechsler Intelligence Scale III (WISC-III; 8-17 years, n=43). Results: Children scored within the normal range (100±15) but significantly below the population mean in several subscales: K-ABC-Achievement-Scale (AS): 90.5±16.2, t(25)=-3.0, p=.006; WISC-III-Performance-IQ (PIQ): 86.2±16.0, t(42)=-5.7, p=.000; WISC-III-Full-Scale-IQ (FIQ): 91.5±17.4; t(42)=-3.2, p=.003. Between 18.5% (SES) and 51.2% (PIQ) of the children scored below the normal range. Regarding all WISC-III-subscales, children with a LRD performed significantly better than children with a postmortem donation (PMD): LRD-VIQ: 102.4±18.4 vs. PMD-VIQ: 89.8±13.3, t(41)=-2.5, p=.014; LRD-PIQ: 92.2±17.6 vs. PMD-PIQ: 80.0±11.4, t(41)=-2.7, p=.010; LRD-FIQ: 97.4±18.6 vs. PMD-FIQ: 85.3±14.0, t(41)=-2.4, p=.021). LRD was associated with higher maternal educational level (r=.28, p=.019). High correlations between the height percentile pre-Ltx and intelligence subscales (r=.44, p=.023 to r=.57, p=.003) were obtained. Conclusion: By assessing exclusively children with biliary atresia, we eliminated confounding due to various primary diseases. We confirmed our main hypothesis: Liver transplanted children with biliary atresia revealed more cognitive restraints compared to the norm. Children's preoperative decelerated body height could be regarded as an index of children's decelerated brain growth, which might be relevant to explain the interrelation between height percentile (pre-Ltx) and cognitive functioning after transplantation. However, family socioeconomic status seems to have a mediating role. Our results emphasize the urgent need of routinely performed psychological diagnostics and support to liver transplanted children.