A NEW CENTURY OF PEDIATRIC TRANSPLANTATION?

T. Kaller¹, N. Langguth¹, B. Nashan², R. Ganschow³, K. Schulz^4
1Institut For Medical Psychology, University Hospital Hamburg, Hamburg/GERMANY, ²Hepatobiliary And Transplant Surgery, University Medical Centre Hamburg - Eppendorf, Hamburg/GERMANY, ³Departement Of Pediatric Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg/GERMANY, ⁴Institute For Medical Psychology, University Hospital Hamburg, Hamburg/GERMANY

Body: Aims: Liver transplanted children have an increased risk to develop serious developmental problems and comorbid disorders. The current study examined attention and executive functioning and their relation to intelligence, behavior, quality of life, and several disease-related factors after transplantation. Methods: Participants (n=137, 54% girls, aged 10.3±3.7 years) completed a neuropsychological assessment battery for attentional performance postoperatively (6.8±3.8 years after transplantation). Mean age at transplantation was 3.7±3.8 years. Thirty-six percent received a living donation. Assessment included: attention and executive functioning (TAP/KITAP), intelligence (WISC/K-ABC), behavior (SDQ), and quality of life (Kidscreen-52). Liver transplanted children were expected to show poorer attention and executive functioning compared to the norm. Moreover, high interrelations between attention performance and intelligence, behavior, quality of life, and disease-related variables were assumed. Results: In most TAP (n=67) and KITAP (n=70) subscales children scored in the lower normal range, but reaction times were significantly below the population mean (T=50±10), i.e., TAP-Alertness (Tonic Alertness: T=46±6, p<.001; Phasic Alertness: T=45±6, p<.001), KITAP-Alertness (T=45±10, p<.001). However, the TAP-Go/NoGo reaction time was significantly above the population mean (T=53±9, p=.002). Reaction times in Alertness and Go/NoGo tasks differed significantly, t(65)=-5.753, p<.001 for TAP-Tonic Alertness and TAP-Go/NoGo, t(65)=-6.879, p<.001 for TAP-Phasic Alertness and TAP-Go/NoGo, t(74)=-2.381, p=.020 for KITAP-Alertness and -Go/NoGo. Most TAP and KITAP subscales, especially Alertness and Go/NoGo, were highly correlated with WISC and K-ABC subscales (r=.29 to .54) indicating that liver transplanted children with lower intelligence scores display longer reaction times. Moreover, significant correlations (r=.26 to .40) were obtained between Alertness and Go/NoGo (TAP/KITAP) and several SDQ subscales (Problems with Peers, Conduct Problems, Total Difficulties, Overall Distress and Social Impairment). Children with longer reaction times suffered from more behavioral problems. Additionally, KITAP-Alertness was significantly correlated with the Bullying subscale of the Kidscreen-52 (r=.29, p=.022). In semi-structured interviews, parents of children with shorter reaction times in Alertness and Go/NoGo tasks (TAP) reported more problems at school or kindergarten after LTX (r=.26, p=.049; r=.31, p=.022). Moreover, children with shorter reaction times in the KITAP-Go/NoGo task showed significantly more restlessness at school (r=.35, p=.034). Regarding disease-related variables, the TAP-Go/NoGo subscale correlated significantly with age at transplantation (r=-.39, p=.001) and duration of illness (r=-.43, p=.001) implying that younger children and children with a shorter duration of illness revealed higher T-scores. Conclusion: Results provide evidence suggesting that liver transplanted children are at risk of developmental deficits and behavioral problems. Deceleration at Alertness tasks (well-documented consequence of various forms of brain damage) but acceleration at Go/NoGo tasks indicate that children skipped the decision-making process required for Go/NoGo performance and treated Alertness and Go/NoGo tasks as equal. That implies liver transplanted children display a deficient control of non-adequate reactions or impulsive behavior. In addition, high correlations between Go/NoGo performance and intelligence, mental health, and quality of life emphasized the relevance of attention and executive functioning, especially response inhibition, for several life domains. In summary, results demonstrate the need for an early and comprehensive developmental screening after pediatric liver transplantation to prevent developmental problems and to ensure the social integration of liver transplanted children.

Disclosure: All authors have declared no conflicts of interest.