title: Longitudinal study of cognitive and academic outcomes after pediatric liver transplantation.
abstract: OBJECTIVE
  To determine the evolution of cognitive and academic deficits and risk factors in children after liver transplantation.
  
  
  METHODS
  Patients ≥2 years after liver transplantation were recruited through Studies of Pediatric Liver Transplantation. Participants age 5-6 years at Time 1 completed the Wechsler Preschool and Primary Scale of Intelligence, 3rd edition, Wide Range Achievement Test, 4th edition, and Behavior Rating Inventory of Executive Function (BRIEF). Participants were retested at age 7-9 years, Time 2 (T2), by use of the Wechsler Intelligence Scales for Children, 4th edition, Wide Range Achievement Test, 4th edition, and BRIEF. Medical and demographic variables significant at P ≤ .10 in univariate analysis were fitted to repeated measures modeling predicting Full Scale IQ (FSIQ).
  
  
  RESULTS
  Of 144 patients tested at time 1, 93 (65%) completed T2; returning patients did not differ on medical or demographic variables. At T2, more participants than expected had below-average FSIQ, Verbal Comprehension, Working Memory, and Math Computation, as well as increased executive deficits on teacher BRIEF. Processing Speed approached significance. At T2, 29% (14% expected) had FSIQ = 71-85, and 7% (2% expected) had FSIQ ≤70 (P = .0001). A total of 42% received special education. Paired comparisons revealed that, over time, cognitive and math deficits persisted; only reading improved. Modeling identified household status (P < .002), parent education (P < .01), weight z-score at liver transplantation (P < .03), and transfusion volume during liver transplantation (P < .0001) as predictors of FSIQ.
  
  
  CONCLUSIONS
  More young liver transplantation recipients than expected are at increased risk for lasting cognitive and academic deficits. Pretransplant markers of nutritional status and operative complications predicted intellectual outcome.
authors.affiliation: Child & Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. Electronic address: Lsorensen@luriechildrens.org.
authors.forename: Lisa G
authors.initials: LG
authors.lastname: Sorensen
authors.affiliation: Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
authors.forename: Katie
authors.initials: K
authors.lastname: Neighbors
authors.affiliation: The EMMES Corporation, Rockville, MD.
authors.forename: Karen
authors.initials: K
authors.lastname: Martz
authors.affiliation: Child & Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
authors.forename: Frank
authors.initials: F
authors.lastname: Zelko
authors.affiliation: Pediatric Liver Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: John C
authors.initials: JC
authors.lastname: Bucuvalas
authors.affiliation: Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
authors.forename: Estella M
authors.initials: EM
authors.lastname: Alonso
mesh_terms: D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000209:etiology*; D004522:Educational Status; D056344:Executive Function; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007361:Intelligence Tests; D007859:Learning Disabilities / Q000209:etiology*; D016031:Liver Transplantation / Q000009:adverse effects*; D008137:Longitudinal Studies; D008297:Male; D012042:Registries; D012307:Risk Factors; D016896:Treatment Outcome