title: 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 <3 yr. 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 (≤12 months and >12 months): 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 (30 days) 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.
authors: Department of Pediatrics, University of Alberta, Edmonton, AB, Canada; Pediatric Rehabilitation Outcomes Unit, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada.
authors: Charlene M T
authors: CM
authors: Robertson
authors: Irina A
authors: IA
authors: Dinu
authors: Ari R
authors: AR
authors: Joffe
authors: Gwen Y
authors: GY
authors: Alton
authors: Jason Y K
authors: JY
authors: Yap
authors: Sonel
authors: S
authors: Asthana
authors: Bryan V
authors: BV
authors: Acton
authors: Reg S
authors: RS
authors: Sauve
authors: Steven R
authors: SR
authors: Martin
authors: Norman M
authors: NM
authors: Kneteman
authors: Susan M
authors: SM
authors: Gilmour
mesh_terms: D001656:Biliary Atresia / Q000628:therapy; D001927:Brain Diseases / Q000175:diagnosis; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D002779:Cholestasis / Q000628:therapy; D003071:Cognition; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007360:Intelligence; D007511:Ischemia; D016014:Linear Models; D017114:Liver Failure, Acute / Q000628:therapy; D016031:Liver Transplantation / Q000009:adverse effects*; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests; D009926:Organ Preservation; D011446:Prospective Studies; D012923:Social Class; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents; D007166:Immunosuppressive Agents; D003404:Creatinine
keywords: infants and toddlers; liver transplantation; outcomes; prediction; preschool