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Pediatr Transplant ; 17(7): 621-30, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-23961979

RESUMEN

This prospective inception cohort study determines kindergarten-entry neurocognitive abilities and explores their predictors following liver transplantation at age <3 yr. Of 52 children transplanted (1999-2008), 33 (89.2%) of 37 eligible survivors had psychological assessment at age 54.7 (8.4) months: 21 with biliary atresia, seven chronic cholestasis, and five acute liver failure. Neurocognitive scores (mean [s.d.], 100 [15]) as tested by a pediatric-experienced psychologist did not differ in relation to age group at transplant (≤12 months and >12 months): FSIQ, 93.9 (17.1); verbal (VIQ), 95.3 (16.5); performance (PIQ), 94.3 (18.1); and VMI, 90.5 (15.9), with >70% having scores ≥85, average or above. Adverse predictors from the pretransplant, transplant, and post-transplant (30 days) periods using univariate linear regressions for FSIQ were post-transplant use of inotropes, p = 0.029; longer transplant warm ischemia time, p = 0.035; and post-transplant highest serum creatinine, (p = 0.04). For PIQ, they were pretransplant encephalopathy, p = 0.027; post-transplant highest serum creatinine, p = 0.034; and post-transplant inotrope use, p = 0.037. For VMI, they were number of post-transplant infections, p = 0.019; post-transplant highest serum creatinine, p = 0.025; and lower family socioeconomic index, p = 0.039. Changes in care addressing modifiable predictors, including reducing acute post-transplant illness, pretransplant encephalopathy, transplant warm ischemia times, and preserving renal function, may improve neurocognitive outcomes.


Asunto(s)
Desarrollo Infantil , Cognición , Trasplante de Hígado/efectos adversos , Atresia Biliar/terapia , Encefalopatías/diagnóstico , Cardiotónicos/uso terapéutico , Niño , Preescolar , Colestasis/terapia , Creatinina/sangre , Femenino , Humanos , Inmunosupresores/uso terapéutico , Lactante , Inteligencia , Isquemia , Modelos Lineales , Fallo Hepático Agudo/terapia , Estudios Longitudinales , Masculino , Pruebas Neuropsicológicas , Preservación de Órganos , Estudios Prospectivos , Clase Social , Factores de Tiempo , Resultado del Tratamiento
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