Kindergarten-age neurocognitive, functional, and quality-of-life outcomes after liver transplantation at under 6years of age.

Abstract

We aimed to describe school-entry age neurocognitive, functional, and HRQL outcomes and their predictors after liver transplant done at age <6years. A prospective cohort of all (n=69) children surviving liver transplant from 1999 to 2014 were assessed at age 55.4 (SD 7.2) months and 38.6 (12.4) months after transplant. Assessment included: the Wechsler Preschool and Primary Scales of Intelligence, Beery-Buktenica Developmental Test of VMI, Adaptive Behavior Assessment System caregiver-completed questionnaire, and PedsQL 4.0 Generic Core Scales. Univariate and multiple linear regression determined predictors of outcomes at P<.05. Neurocognitive and functional outcomes were on average within 1SD of population norms, although shifted to the left (P≤.03), with more patients than expected having scores >2 (3.7-5.9 times more, P≤.007) SD below population norms. Total and Summary HRQL scores were statistically significantly lower than the healthy normative population (P≤.02) and a congenital heart disease group (P≤.02), but similar to children with other chronic health conditions; differences often exceeded the MCID and were lowest in the School functioning domain. There were few predictors on multiple linear regressions, and we could not confirm previous studies that suggested various inconsistent predictors of outcomes. Neurocognitive and functional outcomes scores were highly correlated with HRQL scores except for the School functioning domain, but did not fully explain them. Long-term follow-up of this vulnerable population is important in order to facilitate support for the patient and family, and early intervention for any difficulties identified.