Longitudinal assessment of psychological functioning in children after heart or heart-lung transplantation

Abstract

Background: Despite the increasing numbers of pediatric heart and lung transplants being performed worldwide, longitudinal psychological evaluation of children and adolescents undergoing transplantation remains uncommon. The objective of this study was to assess psychological functioning in a group of patients at 12 months and 3 years after transplantation.

Methods: Thirty-four children and adolescents (mean age at 12-month assessment: 7.9 years [range 1.3 to 15.3 years]) were evaluated after heart (n = 24) or heart-lung (n = 10) transplantation for congenital heart disease (CHD; n = 10), cystic fibrosis (n = 1), cardiomyopathy (CM; n = 21) or primary pulmonary hypertension (n = 2). Standardized measures were used to assess development, cognitive function, mood state and behavior at each test occasion.

Results: Measures of developmental, cognitive and academic function were within the normal range with each test and showed stability over time. About 33% of patients had behavior problems at each test occasion, which is higher than the 10% reported for the normal population, but the prevalence of depression fell from 23% at 12 months to 13% at 3 years. Although there were no significant differences between heart and heart-lung recipients, children with a pre-transplant diagnosis of CHD had poorer scores on cognitive and behavioral parameters than those with CM. In particular, while the prevalence of behavior problems showed a slight decrease over time in the CM group, it increased from 33% at 12 months to 75% at 3 years in the CHD group.

Conclusions: A number of pediatric patients continue to have psychological difficulties 3 years after transplant. Initial diagnosis is an important factor in post-transplant psychological functioning, with a diagnosis of CHD appearing to be a risk factor for greater psychological morbidity, at least in the short and medium term. Further follow-up must address whether such differences persist in the longer term. Patients at risk for poorer psychological outcome need to be identified so that interventions can be implemented to reduce psychological morbidity.