Impaired Neurocognitive Performance in Children after Liver Transplantation

Abstract

To assess longitudinal neurocognitive development after liver transplantation and evaluate factors associated with neurocognitive performance. Data from neurocognitive testing of 65 children (aged <18years) who underwent liver transplantation at Oslo University Hospital between 1995 and 2018 were collected from the testing program after transplantation. The parent-reported version of the Behavior Rating Inventory of Executive Function was used to assess executive function. A total of 104 neurocognitive tests were conducted on 65 patients. At the first test, conducted at a median of 4.1years (IQR, 1.5-5.3years) after transplantation and at a median age of 6.7years (IQR, 5.4-10.5years), the mean full-scale IQ (FSIQ) was 91.7±14, and the mean verbal comprehension index was 92.0±14.5. In the 30 patients tested more than once, there was no significant difference in FSIQ between the first test at a median age of 5.8years (IQR, 5.2-8.5years) and the last test at a median age of 10.8years (IQR, 9.8-12.9years) (87.4±12.9 vs 88.5±13.2; P=.58). Compared with the patients who underwent transplantation a age >1year (n=35), those who did so at age <1year (n=30) had a lower FSIQ (87.1±12.6 vs 96.6±13.8; P=.005) and lower verbal comprehension index (87.3±13.8 vs 95.4±13.0; P=.020). Age at transplantation (P=.005; adjusted for cholestasis: P=.038) and transfusion of >80mL/kg (P=.004; adjusted for age at transplantation: P=.046) were associated with FSIQ. Young age at transplantation and large blood transfusions during transplantation are risk factors for poor neurocognitive performance later in life. Children who undergo transplantation before 1year of age have significantly lower neurocognitive performance compared with those who do so later in childhood. Cognitive performance did not improve over time after transplantation.