Emotional and behavioral problems after pediatric liver transplantation: A quantitative assessment

Abstract

Several uncertainties regarding psychological problems in children who underwent liver transplantation and the need to differentiate these disturbances from those related to the underlying previous chronic liver disease itself exist. This background triggered the present pilot study to investigate, using quantitative assessment methods, the incidence and the type of emotional and behavioral disturbances after liver transplantation. Sixteen liver transplant recipients (aged 5.7-14.4 yr) and 12 age-matched controls with stable chronic liver disease were assessed through the parent report form of Child Behavior Checklist/ 4-18. The mean time elapsed since transplantation was 8.1 yr. No patient or family had received psychological support during chronic liver disease or at any phase of the transplantation process. Transplanted children scored within borderline range for Internalizing and Total Behavioral Problems and within pathological range for Competences, except for the Activity Scale. Transplanted children showed more Total Behavioral (p = 0.005) and Externalizing Problems (p = 0.0005) than controls. Both groups scored within the pathological range for Total Competences with no significant differences between the two groups. Our findings suggest that in the absence of support programs a psychological risk does exist for a long period of time, after transplantation. Regarding Total Behavioral Problems and Externalizing Problems, this risk is higher than in children with chronic liver disease.

Parent- and Youth-Reported Illness Uncertainty: Associations With Distress and Psychosocial Functioning Among Recipients of Liver and Kidney Transplantations

“…In addition, 16.3% of these adolescents met full criteria for PTSD, a percentage much higher than general population prevalence estimates. Similarly, Gritti et al (2006) found that, based on maternal responses on the Child Behavior Checklist, pediatric recipients of liver transplants had significantly higher ratings of behavioral problems than age-matched controls with chronic liver disease. More recently, Wu, Aylward, Steele, Maikranz, and Dreyer (2008) found that children and adolescents who had received liver and kidney transplantations evidenced elevated parent-reported symptoms of distress (i.e., internalizing symptoms) relative to the Behavioral Assessment System for Children (BASC; Reynolds & Kamphaus, 1992) normative sample, although the youths themselves reported no such elevations.…”

Current Lifestyle of Young Adults After Liver Transplantation During Childhood

“…Nearly (QOL) and that QOL improves with time after transplantation (6)(7)(8)(9)(10)(11)(12). (9,11,13,(17)(18)(19)(20). However, in contradiction with impaired neuropsychological development, it was reported that LT did not greatly affect schooling (7,10,13,17,21).…”

“…(9,11,13,(17)(18)(19)(20). However, in contradiction with impaired neuropsychological development, it was reported that LT did not greatly affect schooling (7,10,13,17,21). Most of these pediatric studies were conducted among heterogeneous samples with respect to age and the period since LT, and psychological and social development has often been assessed by parental reports (8)(9)(10)(11)21).…”

Long-term nutritional and cognitive outcomes after liver transplantation in childhood

“…Other centres, however, have reported up to 50% of children having adverse psychological reactions with more than 50% having behavioural or emotional disturbances 114,115 . Gritti et al report decreased total behavioural competency and increased externalizing behaviour including aggression and delinquency with 72% exhibiting immaturity of ego and drives 115,116 . There were also more depressive feelings, anxiety, as well as lower parent reported quality of life than in other chronic illness including kidney transplant survivors 112,115,116 .…”

“…Gritti et al report decreased total behavioural competency and increased externalizing behaviour including aggression and delinquency with 72% exhibiting immaturity of ego and drives 115,116 . There were also more depressive feelings, anxiety, as well as lower parent reported quality of life than in other chronic illness including kidney transplant survivors 112,115,116 . More studies, especially those with long-term follow up, examining psychosocial function in this population are needed to identify risk factors for developing future psychological problems.…”