Neurocognitive outcomes at kindergarten entry after liver transplantation at <3 yr of age

Abstract

This prospective inception cohort study determines kindergarten-entry neurocognitive abilities and explores their predictors following liver transplantation at age <3yr. Of 52 children transplanted (1999-2008), 33 (89.2%) of 37 eligible survivors had psychological assessment at age 54.7 (8.4) months: 21 with biliary atresia, seven chronic cholestasis, and five acute liver failure. Neurocognitive scores (mean [s.d.], 100 [15]) as tested by a pediatric-experienced psychologist did not differ in relation to age group at transplant (≤12months and >12months): FSIQ, 93.9 (17.1); verbal (VIQ), 95.3 (16.5); performance (PIQ), 94.3 (18.1); and VMI, 90.5 (15.9), with >70% having scores ≥85, average or above. Adverse predictors from the pretransplant, transplant, and post-transplant (30days) periods using univariate linear regressions for FSIQ were post-transplant use of inotropes, p=0.029; longer transplant warm ischemia time, p=0.035; and post-transplant highest serum creatinine, (p=0.04). For PIQ, they were pretransplant encephalopathy, p=0.027; post-transplant highest serum creatinine, p=0.034; and post-transplant inotrope use, p=0.037. For VMI, they were number of post-transplant infections, p=0.019; post-transplant highest serum creatinine, p=0.025; and lower family socioeconomic index, p=0.039. Changes in care addressing modifiable predictors, including reducing acute post-transplant illness, pretransplant encephalopathy, transplant warm ischemia times, and preserving renal function, may improve neurocognitive outcomes.