Annual Meeting of the North American Society for Pediatric Gastroenterology and Nutrition; Orlando, October 22-24, 1998
COGNITIVE FUNCTION IN PEDIATRIC LIVER TRANSPLANT (LT) RECIPIENTS
Most childhood LT recipients resume their education in regular classrooms. Previous studies have suggested that some may have delays or deficits in cognitive ability resulting in poor academic performance. The purpose of this study was to measure cognitive ability and academic achievement in children who are long-term survivors of LT, compare their function to a control group of children with chronic illness, and attempt to identify risk factors which may predispose them to poor educational outcomes. Methods: The study group included 20 children ages 4 - 12 yrs. and at least two years post LT. The control group included 15 children with cystic fibrosis (CF), matched to the study group for age, educating and parental education. Each child was tested for IQ (WISC-III or WPPSI-R), language skills (CELF-R or CELF-P) and academic achievement (Woodcock-Johnson Tests of Achievement-Revised). Risk factors evaluated included; age at LT, UNOS status, number of grafts, days in ICU, hospital days the first year, and pre-transplant labs. Results: The mean age of the LT group was 6.95±2.11 yrs. and mean age at LT was 2.4± 2.8 yrs. Indicators for LT were Biliary Atresia (n=16), biliary cirrhosis (n=4). 5 had received multiple grafts. The mean Full Scale IQ of the LT group was 91.2± 19.1 (range 60-123,4 patients had FSIQ < 70), CF groupmean 99.3±17.7; p=NS. There was, however, a trend toward lower Verbal IQ scores in the LT vs. the CF group, mean 88.4±19.4 vs. 99.5±17.9; p<0.09. Achievement scores were within the average range and did not differ from the CF group. Total Language Scores were lower in the LT vs. CF group, mean standard score 79.5±14.6 vs. 90.9±16.5; p<0.05, with receptive language showing the most difference, LT group 82.3±15.7, CF group 95.9±16.9; p<0.03. Serum total bilirubin pretransplant was negatively correlated with Verbal IQ p<0.02 and expressive language p<0.03.No other risk factors for poor performance were identified. When children with multiple transplants were excluded from analysis, hospital days the first year after transplant negatively correlated with Verbal IQ p<0.0004, receptive language p<0.006, math p<0.003 and writing p<0.03 skills, and expressive language p<0.03. Conclusion: Most children who have survived liver transplantation do not have obvious cognitive deficits. However, when compared to children with cystic fibrosis, they have lower Verbal IQ and receptive language scores. Pre-transplant bilirubin level and duration of hospitalization after LT may predict which patients are most likely to experience speech and language difficulties.
Hepatology© 1998 Lippincott Williams & Wilkins, Inc.