Psychological impact of liver transplantation on children's inner worlds

We carried out an in-depth evaluation of psychosocial status in a sample of 18 children (mean age 6.8 yr, range 4.4-10.8 yr) who had suffered from sev ere liver disease and undergone orthotopic liver transplantation (OLT). Mea n age at: OLT was 3.4 yr. The assessment was psychoanalytically oriented an d included individual sessions and testing procedures for children - the Ch ildren Apperception Test (CAT), the Weschsler Intelligence Scale for Childr en (WISC-R), the Weschsler Preschool and Primary Scale of Intelligence (WIP PSI), and the Human Figure Test - and a semi-structured interview with a se parate questionnaire for parents. Patients were compared with an age- and g ender-matched control group. The main findings in patients compared with co ntrols were: IQ 91.6 (range 70-117) vs. 118 (range 94-135) (p <0.0001); imm aturity of ego and drives (72.2% vs. 27.7%; p=0.018), fear of death (61.1% vs. 11.1%; p=0.04), anxiety of loss (50% vs. 27.7%; p=NS, and depressive fe elings (61.1% vs. 22.2%; p=0.04); a mild defect of body image (44.4% vs. 33 .3%; p=NS) associated with recurrent representations of motionless (72.2% v s. 38.8%; p=NS) and inexpressive (88.8% vs. 16.6%; p <0.0001) human figures . Fantasies about OLT as a 'magic rebirth' or a 'body transformation' were detected in few patients (30%). Although a recurrent set of feelings, confl icts, and fantasies about OLT were expressed by children, individual specif ic psychological responses to this experience were often detected. In spite of the fact that approximate to 50% of the parents mentioned emotional or behavioral disturbances of their child, only three parents were seriously c oncerned about this problem. The theme of transplantation was most often ab sent from communication between the child and their parents. Our results su ggest that psychic 'working through' of the chronic liver disease and OLT e xperience is difficult for children. Further studies are necessary to verif y whether changes of parental attitude to OLT as a 'family secret' may faci litate integration of the OLT experience in the child's personality develop ment.