Parents and teachers completed the Behavior Rating Inventory of Executive Function (BRIEF). Participants performed significantly below test norms on intelligence quotient (IQ) and achievement measures (Mean WPPSI-III Full Scale IQ = 94.7 �� 13.5; WRAT-4 Reading = 92.7 �� 17.2; WRAT-4 Math PFI 2
= 93.1 �� 15.4; p < 0001). Twenty-six percent of patients (14% expected) had ��mild to moderate�� IQ delays (Full Scale IQ = 71�C85) and 4% (2% expected) had ��serious�� delays (Full Scale IQ �� 70; p < 0.0001). Reading and/or math scores were weaker than IQ in 25%, suggesting learning disability, compared to 7% expected by CDC statistics (p < 0.0001). Executive deficits were noted on the BRIEF, especially by teacher report (Global Executive Composite = 58; p < 0.001). Results suggest a higher prevalence of cognitive and academic delays and learning problems in pediatric LT recipients compared to the normal population. Neurological injury early in life due to conditions such as perinatal complications, traumatic brain injury and cancer has the potential to inflict significant, long-lasting developmental consequences (1�C4). Hepatic encephalopathy and other neurological insults associated with end-stage liver disease may have a similar potential. The majority of http://www.selleckchem.com/
pediatric liver transplant recipients experience end-stage liver disease early in life, and in most large series, the median age at transplantation is less than 2 years (5,6). In the decades since the first pediatric liver transplantation (LT), major strides have been made in managing morbidity and limiting mortality in this patient group, but significant concerns remain regarding functional outcomes in children following LT, especially in the areas of cognitive function and school performance (7,8). Few studies have examined neurocognitive outcomes in pediatric patients with liver disease and transplantation. Nevertheless, evidence is mounting to suggest pediatric recipients of LT experience significant cognitive deficits ranging from a depression in overall intelligence quotient (IQ) to less obvious neuropsychological dysfunction (9�C13). Mean IQ scores typically fall in the low average to average range, with overrepresentation at the lower end of the IQ spectrum. Early disease onset, poor nutritional status and growth deficits, and longer MG-132 mouse
duration of illness prior to transplant have been implicated as factors associated with poorer outcomes (14�C16). A handful of studies have reported an increased prevalence of learning problems including below average academic achievement (9), IQ/achievement discrepancy (11), and parent report of learning disability and special education services (17). Although problems with attention and executive function (EF) have also been noted anecdotally, these domains have yet to be systematically examined in pediatric LT recipients.