| Part I Evaluation of Cognitive Function in Children after LiverTransplantationObjective :To evaluate the cognitive development of children at least one year after liver transplantation,and to provide reference for the long-term prognosis and clinical treatment of children after liver transplantation in China.Methods: Children aged from 2 years and 6 months to 6 years and 11 months were selected from Renji Hospital Affiliated to Medical College of Shanghai Jiaotong University for one year after liver transplantation from 2011 to 2017.The composite scores of total IQ and indices were obtained from the assessment of children's cognitive function used by the Chinese version of Wechsler Preschool and Primary Scale of Intelligence-fourth Edition(WPPSI-IV)and compared with the normal values of the norm.According to the age at the time of liver transplantation,they were divided into less than one year old group(group A)and older than one year old group(group B),then compared with the normal value of the norm and the differences of the sub-indices between groups.Results: The mean total IQ of 87 children after liver transplantation was 95.55,the standard deviation was 12.91,which was significantly lower than the normal value of the domestic norm(P<0.01).The mean total IQ of group A was 97.35,the standard deviation was 13.01,there was no statistical difference between group A and the normal value.The mean total IQ of group A was 90.23,the standard deviation was 11.26,the difference was statistically significant compared with the normal value(P<0.01).The total IQ of group A was significantly higher than that of group B(P<0.05).Conclusion: The cognitive development of children after liver transplantation lags behind that of normal children in China.The development of cognitive function in children younger than one year old at the time of liver transplantation was better than that in children older than one year old.Part II Causes of Cognitive Development Deficits Impairment after liver Transplantation in ChildrenObjective: To explore and analyze the possible influencing factors of cognitive impairment in children after liver transplantation,so as to provide clinical reference for improving the long-term prognosis of children after liver transplantation.Methods: WPPSI-IV Chinese version was used to evaluate the cognitive function of 87 children after liver transplantation.The total intelligence quotient(IQ)and the composite scores of each index were obtained.Data of 87 children before and after transplantation were collected.Including preoperative diagnosis,sex,age at transplantation,height,weight,Child-Pugh grading score,relevant biochemical examinations,intraoperative conditions;days of hospitalization after transplantation,days of hospitalization in ICU,times of infection,time of re-liver transplantation,times of re-revision surgery;and the basic situation of children at this stage,such as blood routine,liver function and other biochemical indicators,blood concentration of immunosuppressive agents,residence and parents' education.The influence of gender,parental education,residence and other non-disease factors on cognitive function of children after liver transplantation was analyzed by analysis of variance(ANOVA).The risk factors of cognitive deficit after liver transplantation were explored by stepwise regression analysis.Results: There were 87 children after liver transplantation,37 males(42.53%)and 50 females(57.47%).Gender,residence and education level of parents of liver transplantation children as non-disease factors,the use analysis of variance showed that women were a factor,and women's total IQ was better than men's,P < 0.05,there was significant difference.However,children's residence and educational level of their parents were not related to the prognosis of the total intelligence quotient after liver transplantation.Regression analysis showed that four predictors could be used as risk factors for cognitive development deficits in children after liver transplantation.1.The median percentile of body weight during liver transplantation is the most important predictor of cognitive development in children after liver transplantation.It can be used as a predictor of cognitive function such as verbal comprehension,visual space,fluid reasoning,working memory score index and total intelligence quotient.The lower the body weight duringtransplantation,the more likely the cognitive development will be impaired.2.From liver transplantation to assessment time,it can significantly predict the total IQ,visual spatial and working memory scores.That is,the longer the time from liver transplantation to assessment,the better the neurocognitive development.3.Child-Pugh improved score can also significantly predict the scores of TIQ,visual spatial and fluid reasoning.The higher the score,the more vulnerable the neurocognitive development of children after liver transplantation is.4.ICU hospitalization days can significantly predict the processing speed score.The longer the ICU hospitalization time,the lower the processing speed score.Conclusion: Median percentile body weight at the time of liver transplantation,Child-Pugh modified scale score,time from liver transplantation to evaluation,and days in ICU were used as four predictors of cognitive developmental deficits in children after liver transplantation.Nutrition status and severity of liver disease before liver transplantation in children may be important factors affecting the outcome of cognitive development in children after liver transplantation. |
PDF Full Text Request