Neurodevelopmental outcomes in pediatric heart transplant recipients.

BACKGROUND

Physical functioning is without restriction in most pediatric heart transplant survivors, but only limited data are available about neuropsychologic outcomes in these children. In this study we assess neurodevelopmental outcomes in transplant survivors in comparison to population norms.

METHODS

Neuropsychologic evaluations were performed 12 to 24 months (mean 16 months) post-transplant in 21 children ranging in age from 1 to 101 months (median 15 months) at time of transplant. Outcomes included verbal, non-verbal and overall intelligence; visual-motor integration skills; and adaptive functioning.

RESULTS

Transplant recipients had a mean overall IQ of 86.7, verbal IQ of 88.4 and non-verbal IQ of 87.5, all significantly below the normative population mean of 100 (p < 0.01). Thirty-eight to 43% of subjects had low IQ scores (i.e., <85), significantly more than the normative 16% base rate (p < 0.02). Children with an initial diagnosis of congenital heart disease (CHD) had lower overall IQ (mean 78.6) than those with cardiomyopathy (mean 91.7). The mean expressive language score was 88.1, significantly below norms (p < 0.01), with 46% having low scores (p = 0.01). Receptive language was normal in the same patients (mean 96.8). Finally, 63% of patients had visual-motor deficits and 48% had fine motor deficits (p < 0.005 compared with norms).

CONCLUSIONS

Although many pediatric heart transplant recipients display normal neurodevelopmental functioning, this population is at increased risk for cognitive difficulties, especially in expressive language, visual-motor integration and fine motor skills. Children with CHD may be at especially high risk. Early identification and intervention are essential to promote optimal neuropsychologic outcomes and overall quality of life in pediatric heart transplant recipients.