Sorensen Lisa G, Neighbors Katie, Martz Karen, Zelko Frank, Bucuvalas John C, Alonso Estella M
Child & Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
J Pediatr. 2014 Jul;165(1):65-72.e2. doi: 10.1016/j.jpeds.2014.03.032. Epub 2014 May 5.
To determine the evolution of cognitive and academic deficits and risk factors in children after liver transplantation.
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).
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.
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.
确定肝移植术后儿童认知和学业缺陷的演变情况及危险因素。
通过小儿肝移植研究招募肝移植术后≥2年的患者。在时间1时年龄为5 - 6岁的参与者完成了韦氏学前及初小儿童智力量表第三版、广泛成就测验第四版和执行功能行为评定量表（BRIEF）。参与者在7 - 9岁时（时间2，T2）再次接受测试，使用韦氏儿童智力量表第四版、广泛成就测验第四版和BRIEF。在单因素分析中P≤0.10时具有显著意义的医学和人口统计学变量被纳入重复测量模型，以预测全量表智商（FSIQ）。
在时间1测试的144名患者中，93名（65%）完成了T2测试；回访患者在医学或人口统计学变量方面无差异。在T2时，FSIQ、言语理解、工作记忆和数学计算低于平均水平的参与者比预期更多，并且教师版BRIEF显示执行功能缺陷增加。处理速度接近显著水平。在T2时，29%（预期为14%）的参与者FSIQ = 71 - 85，7%（预期为2%）的参与者FSIQ≤70（P = 0.0001）。共有42%的参与者接受特殊教育。配对比较显示，随着时间推移，认知和数学缺陷持续存在；只有阅读能力有所提高。模型确定家庭状况（P < 0.002）\n、父母教育程度（P < 0.01）、肝移植时的体重z评分（P < 0.03）和肝移植期间的输血量（P < 0.0001）为FSIQ的预测因素。
比预期更多的年轻肝移植受者面临持续认知和学业缺陷风险增加的情况。营养状况和手术并发症的移植前标志物可预测智力结果。
