Academic and Cognitive Adjustment

A review of cognitive outcomes for pediatric heart transplant patients found that most children and adolescents were functioning within the average range posttransplant, although research indicates that these patients' performance is often lower than that of their healthy peers (Todaro et al. 2000; Wray et al. 2001). One study of children who received heart transplants as infants revealed that children were at risk for deficits in visuospatial skills and scored in the lower ranges for IQ and achievement at higher rates than expected (Baum et al.

2000). Other studies indicated more significant deficits. For example, Brosig et al. (2006) found that 46% of heart transplant patients scored two standard deviations below the normative population on measures of cognitive functioning.

Moreover, pediatric patients who experience post-transplant complications (e.g., infection, rejection) may be at greater risk for cognitive issues (Todaro et al. 2000). For example, neurological complications are not uncommon in lung transplant patients. One study found that 45% of pediatric lung transplant patients had neurological complications, most often seizures but also encephalopathy, headache, depression, and focal neurological deficits (Wong et al. 1999). In addition, studies on cognitive development have indicated that after liver transplantation, children show postoperative results on cognitive assessments in the lower normal range compared with healthy peers (Kaller et al. 2005), with particular deficits in the domains of learning and memory, abstract thinking, visuospatial abilities, and motor control (Stewart et al. 1991). Favorable prognostic factors include children who are younger, have had a shorter duration of illness, and are more physically developed at the time of transplant (Kaller et al. 2005). Also, studies of adult patients have demonstrated improved cognitive abilities following liver transplantation (Rovira et al. 2007).

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