Association of Functional, Academic, Motor, and Cognitive Deficits in Graft Failure in Pediatric Liver Transplantation

ABSTRACT Introduction Predicting graft failure risk in pediatric liver transplantation (LT) recipients could identify areas for improving management. Persistent cognitive, motor, academic, and functional deficits are common in recipients and their impact on graft survival following LT helps inform risk prediction. Methods Using SRTR data 2008–2023, we evaluated the cognitive, motor, academic, and functional deficits of LT recipients at time of transplant to 14 years post‐LT. We compared all cause graft failure (ACGF) among patients with versus without pre‐LT and 1‐year post‐LT deficits using Cox regression, adjusting for recipient characteristics. We calculated an individual risk score for ACGF. Results In 8062 pediatric LT recipients median age 3 (IQR: 1, 10), 28.0%, 29.5%, 35.0%, and 79.8% of recipients had pre‐LT deficits in cognition, motor, academic activity, and functional status respectively. This decreased to 23.0%, 18.1%, 14.2%, and 38.7% 1‐year post‐LT. Increased hazard of ACGF was noted in recipients with pre‐LT decreased functional status (aHR = 1.13 (per 10% decrease), 95% CI: 1.10–1.15, p < 0.001), definite motor delay (aHR = 1.60, 95% CI: 1.21–2.10, p < 0.001), and inability to participate in academics (aHR = 1.49, 95% CI: 1.08–1.89, p = 0.01), but not delays in cognition (aHR = 0.91, 95% CI: 0.69–1.21, p = 0.19). Our risk score predicting ACGF demonstrated improved predictive performance compared to clinical parameters alone (C‐statistic = 0.70 (0.67, 0.72) vs. 0.66 (0.64, 0.69), p < 0.001). Conclusions Pediatric LT recipients with pre‐ or post‐LT motor, academic, and functional deficits are at higher risk for ACGF. Care should be taken to assess deficits to identify patients who may benefit from functional intervention to potentially reduce ACGF risk.