Neurodevelopmental Outcomes of Infant Multivisceral Transplant Recipients: A Longitudinal Study D.M. Thevenin, A. Baker, T. Kato, A. Tzakis, M. Fernandez, and M. Dowling ABSTRACT This longitudinal investigation compares cognitive and physical capabilities of transplant recipients, both before and after receiving an intestinal transplant. Methods. Using the Bayley Scales of Infant Development, we conducted pretransplant and posttransplant assessments on nine children (4 males, 5 females) who received either an isolated intestine, combined intestine and liver, or multivisceral transplants, with a mean age at transplant of 18 months (range 8 –29) and a mean time posttransplant of 2 months (range 1– 4 months). Results. Scores on the Mental Developmental Index reflected that a majority (55.6%) of patients who scored in the significantly delayed range prior to transplant remained in the significantly delayed classification after receiving a transplant. In addition, 33.3% showed a decrease in their mental classification; either from “mildly delayed” to “significantly delayed” or from “within normal limits” to “mildly delayed”. Results on the Motor Developmental Index demonstrated that 78% of recipients had significant delays both before and after receiving a transplant, while 11.1% fell one standard deviation after transplantation. We found that the majority of children who experience developmental delays prior to transplant are still experiencing delays when they are discharged from inpatient care. In addition, those children receiving multivisceral transplantations, as opposed to an isolated bowel, may be at a much greater risk of developing and retaining both cognitive and physical delays. Early neurodevelopmental evaluations of these patients is essential for early parental education and compliance with early intervention services to maximize potential recovery and ability to obtain normal de- velopment. O UR PREVIOUS investigations of neurodevelopmen- tal outcomes of infant intestinal transplants found that these children continued to experience delays for many years posttransplant. Presently, it is unclear when parents can expect that their children will begin showing measur- able signs of developmental catch up. 1–3 For this study, we were most interested in whether these children had already experienced developmental delays prior to transplant and how do these children look developmentally once they are ready to be discharged from inpatient care. Parents often believe their children will be normal after transplant, par- ticularly when the child is finally determined to be medically stable and ready to be discharged. We wanted to be able to advise parents about what to expect regarding their chil- dren’s cognitive and physical abilities before and after receiving an intestinal transplant. We included infants who received either an intestine, a combined intestine/liver, or a multivisceral transplant in the study. METHODS We conducted pretransplant and posttransplant neurodevelop- mental evaluations on a total of nine infants and toddlers who were all candidates for organ transplant. Assessments were first done before they received a transplant and then were repeated again From the Departments of Pediatrics (D.M.T., A.B., M.F., M.D.) and Surgery (T.K., A.T.), University of Miami/Miller School of Medicine, Miami, Florida, USA. Funded by the State of Florida’s Children’s Medical Services. Address reprint requests to Dr Deborah M. Thevenin, Univer- sity of Miami/Miller School of Medicine, UMMG Physician- Patient Advocacy Program, P. O. Box 019132 (R58), Miami, FL 33101. E-mail: dthevenin@med.miami.edu 0041-1345/06/$–see front matter © 2006 by Elsevier Inc. All rights reserved. doi:10.1016/j.transproceed.2006.05.036 360 Park Avenue South, New York, NY 10010-1710 1694 Transplantation Proceedings, 38, 1694 –1695 (2006)