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    Impact of immunosuppression on executive functioning after pediatric liver transplantation. An observational cohort study

    Objectives: Children after liver transplantation (LTx) show increased rates of impaired cognitive functioning. We aimed to assess the potential effects of immunosuppressive therapy on executive functioning measured by the Children’s Colour Trail Test (CCTT) and the cognitive functioning module of the PedsQL(cogPedsQL) in liver transplanted children in order to explore potential targets for intervention to improve executive functioning.

    Methods: We performed a cross-sectional study in 155 children (78 female) aged 10.4 (2–18) years at 5.0 (0.1–17) years after LTx, with follow-up at 6 months in n = 114. Executive functioning was assessed by CCTT (ages 8–16) and by patients & parent-proxy cogPedsQL. (ages 5–18/2–18 respectively). Results were correlated with clinical parameters. Stability of results over time was compared between n = 23 patients who for clinical reasons switched from twice daily calcineurin inhibitor (CNI) to once-daily slow-release tacrolimus during the study period, and patients with unchanged CNI.

    Results: Worse executive functioning was associated with longer stay in the ICU and longer time elapsed since transplantation. No difference was found between users of cyclosporin and tacrolimus. Children on once-daily slow-release tacrolimus performed better than children on twice-daily tacrolimus. In children who switched from twice-daily CNI to once-daily tacrolimus, parent-proxy cogPedsQL improved significantly compared to stable results in the non-switch group.

    Conclusions: Besides a strong impact of disease burden around transplantation, executive functioning appears to deteriorate over time. While there is no clear-cut advantage of any CNI, once-daily tacrolimus appears to be advantageous compared to twice-daily tacrolimus.


    Goldschmidt, I., Van Dick, R., Jacobi, C., Junge, N., Pfister, E. Richter, N., & Baumann, U. (2019). Impact of immunosuppression on executive functioning after pediatric liver transplantation. An observational cohort study. Journal of Pediatric Gastroenterology and Nutrition, 68, 480-487. doi:10.1097/MPG.0000000000002274

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