Impaired Neurocognitive Performance in Children after Liver Transplantation

Anniken B Østensen; Anne-Britt Skarbø; Truls Sanengen; Pål-Dag Line; Runar Almaas

doi:10.1016/j.jpeds.2021.12.033

Impaired Neurocognitive Performance in Children after Liver Transplantation

J Pediatr. 2022 Apr:243:135-141.e2. doi: 10.1016/j.jpeds.2021.12.033. Epub 2021 Dec 23.

Authors

Anniken B Østensen¹, Anne-Britt Skarbø², Truls Sanengen², Pål-Dag Line³, Runar Almaas⁴

Affiliations

¹ Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
² Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.
³ Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.
⁴ Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Pediatric Research, Oslo University Hospital, Oslo, Norway. Electronic address: runar.almaas@ous-hf.no.

PMID: 34953814
DOI: 10.1016/j.jpeds.2021.12.033

Abstract

Objectives: To assess longitudinal neurocognitive development after liver transplantation and evaluate factors associated with neurocognitive performance.

Study design: Data from neurocognitive testing of 65 children (aged <18 years) 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.

Results: A total of 104 neurocognitive tests were conducted on 65 patients. At the first test, conducted at a median of 4.1 years (IQR, 1.5-5.3 years) after transplantation and at a median age of 6.7 years (IQR, 5.4-10.5 years), 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 5.8 years (IQR, 5.2-8.5 years) and the last test at a median age of 10.8 years (IQR, 9.8-12.9 years) (87.4 ± 12.9 vs 88.5 ± 13.2; P = .58). Compared with the patients who underwent transplantation a age >1 year (n = 35), those who did so at age <1 year (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 >80 mL/kg (P = .004; adjusted for age at transplantation: P = .046) were associated with FSIQ.

Conclusions: 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 1 year 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.

Keywords: BRIEF; IQ; age; complications.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child
Child, Preschool
Cognition
Executive Function
Humans
Liver Transplantation* / adverse effects
Mental Status and Dementia Tests
Prospective Studies
Risk Factors