Year: 2013
Type: dissertation
Study design: Observational Study
Abstract: Organ transplantation (Tx) is a life-saving procedure for patients with end-stage organ failure. Survival rates have improved in recent decades, but the prevalence of neurological and psychiatric morbidities remain high. This is the first study to comprehensively assess cognitive and behavioral outcomes in a national sample of Finnish children who have undergone heart, kidney, or liver Tx. It presents data on 87 children who received transplants between 1993 and 2008. The first aim of this thesis was to assess both global intelligence and a specific neuropsychological profile of pediatric heart, kidney, and liver Tx recipients. The second aim was to compare health-related quality of life and psychosocial adjustment between the Tx groups. Within the cognitive outcome variables, a generalized effect on intelligence was observed, on a group level, in children who underwent heart or kidney Tx, particularly in children with neurological abnormality. Liver Tx children had age-appropriate intelligence. All Tx groups tended to have more problems in nonverbal than in verbal intelligence. In neuropsychological functions, specific visuomotor and visuoconstructive impairment emerged in all Tx groups. In children without neurological comorbidity, few problems emerged in attention, language, or memory and learning. Of the risk factors, early onset and longer disease duration prior to Tx were associated with poorer cognitive outcome, particularly in nonverbal functions. Also, poorer graft function at the time of assessment was associated with lower verbal functions, attention, and memory in kidney Tx children. Within the behavioral outcome variables, no significant differences were observed between heart, kidney, and liver Tx recipients. Parents and teachers reported an increase in internalizing and in the total number of psychiatric symptoms, but these were attributable mainly to a significant increase in somatic complaints. The Tx children themselves found that their health made it more difficult to be with friends, for example, and attend school or hobbies. Of the risk factors, shorter follow-up time after Tx was associated with poorer behavioral outcome. Neurological comorbidity was associated with both self- and proxy-reported behavioral outcome, yet family structure (child not living with both biological parents) and poorer parental health-related quality of life were also negatively associated with the child s adjustment. The outcomes of the majority of school-aged children who have undergone an organ Tx are reassuring. However, a significant minority exhibit considerable global cognitive delay. Additionally, the cognitive profile suggests that Tx children may be susceptible to negative effects in the posterior cortex with associated visuospatial difficulties. Thus, follow-up evaluations of children who have undergone Tx need to include assessment of both intelligence and of other neuropsychological functions, particularly in the domains of visuomotor, visuoconstructive, and visuospatial functions. Further, Tx children and their families should be offered psychosocial support. During cognitive and socioemotional development, new issues may arise; consequently, counseling as a routine part of treatment throughout childhood and adolescence is essential.
Source: Työväentutkimus Vuosikirja
Author: Anu Haavisto
Language: English
Subfield: Transplantation
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1484117969