Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center of Clinical Psychology and Rehabilitation, University of Bremen, Bremen, Germany.
Am J Transplant. 2013 Nov;13(11):2956-65. doi: 10.1111/ajt.12408. Epub 2013 Sep 18.
To date, the course of cognitive development in children after liver transplantation (Ltx) is poorly understood. Cognitive performance, however, is crucial in all developmental stages and for educational achievement. This cross-sectional single-center study examined the prevalence of long-term cognitive impairment in a cohort of 64 pediatric patients after Ltx. Median age at Ltx was 12 months. The revised Wechsler Intelligence Scale IV was administered to assess cognitive performance. Patients were compared with an age- and gender-matched group of children without a chronic health condition. Liver transplanted children performed significantly worse in three of four cognitive domains as well as in the Total Intelligence Quotient (Total IQ) (p = 0.017 to p = 0.005). Liver transplant recipients showed substantially more "serious delays" (IQ < 70) compared to the reference group (9.4% vs. 4.7%). Children with a genetic-metabolic disease performed worse than the other groups in three of the four WISC Indices and in the Total IQ (p = 0.05 to p = 0.01). The strongest association was revealed between height at Ltx and Verbal Comprehension (R(2) = 0.21), Perceptual Reasoning (R(2) = 0.30), Working Memory (R(2) = 0.23) and Total IQ (R(2) = 0.25). Our results indicate a high impact of primary diagnosis and height percentile at Ltx even on children's long-term cognitive performance.
迄今为止，人们对肝移植（Ltx）后儿童认知发展的过程知之甚少。然而，认知表现对于所有发育阶段和教育成就都至关重要。这项横断面单中心研究检查了 64 名 Ltx 后儿科患者队列中长期认知障碍的患病率。Ltx 的中位年龄为 12 个月。采用修订后的韦氏智力量表 IV 评估认知表现。将患者与无慢性健康状况的年龄和性别匹配的儿童组进行比较。在四个认知领域中的三个领域以及总智商（Total IQ）中，肝移植儿童的表现明显更差（p=0.017 至 p=0.005）。与参考组相比，肝移植受者的“严重延迟”（IQ<70）明显更多（9.4%比 4.7%）。在四个 WISC 指数中的三个和总智商中，患有遗传代谢疾病的儿童比其他组表现更差（p=0.05 至 p=0.01）。在 Ltx 时的身高与言语理解（R²=0.21）、知觉推理（R²=0.30）、工作记忆（R²=0.23）和总智商（R²=0.25）之间存在最强的关联。我们的结果表明，主要诊断和 Ltx 时的身高百分位对儿童的长期认知表现有很大影响。
