Incidence of Cognitive Dysfunction in Children After Liver Transplantation: A Systematic Review and Meta‐Analysis

This study aimed to systematically review the incidence and factors associated with cognitive dysfunction in children after liver transplantation. Four electronic databases (PubMed, Embase, Web of Science, and ProQuest) were searched from inception to October 22, 2024. Study quality and risk of bias were assessed using the Newcastle-Ottawa Scale (NOS). The pooled incidence was calculated using R software (version 4.3.1). We performed a narrative review to summarize the factors associated with cognitive dysfunction in children after liver transplantation. The protocol of this study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) database, registration number: CRD42025630498. This study included 38 articles involving 7494 participants. The pooled incidence of cognitive dysfunction following pediatric liver transplantation was estimated at 24% (95% CI: 19.0%-30.0%). Highest rates were observed in Asia (30.6%) and among children transplanted < 1 year-old (39.4%). Disease-related factors, treatment-related factors, individual factors, cognitive-behavioral factors and social factors were summarized. Collected evidence showed that the overall incidence of cognitive dysfunction in children after liver transplantation was high. A multifactorial approach to risk assessment and intervention is needed to optimize long-term cognitive outcomes in this vulnerable population.