We screened for behavioral health symptoms in pediatric liver transplantation (LT) recipients to determine associations with lab measures of graft injury using the Patient-Reported Outcomes Measurement Information System (PROMIS) scales. Pediatric LT recipients >0.5 yr post LT and >5 yrs. of age were enrolled by convenience sampling in an ambulatory clinic. PROMIS questionnaires were completed by parent proxy and self-report. PROMIS T-score population norm is 50±10 with higher scores indicating more symptoms. Agreement between self and parent proxy report was determined by Intraclass Correlation Coefficients (ICC). Univariate analysis assessed the relationship between PROMIS domains, gender, age, and liver enzymes. 34 patients were assessed. Mean age was 10.6±3.5 yrs. with 64% male, 82% Caucasian and 47% had Biliary atresia. 44% were on monotherapy. Median interval from LT was 5.1 (range 0.5-13.9) yrs. 27% had abnormal alanine aminotransferase (ALT), 18% had abnormal aspartate aminotransferase (AST) and 15% had abnormal gamma-glutamyl transpeptidase (GGTP). Mean self-report T scores were; fatigue 1.7±12.1, anxiety 43.6±10.5, and depression 44.2±9.8. Mean parent proxy scores were; fatigue 46.5±10.4, anxiety 47.5±11.6 and depression 47.5±11.6. ICC were 0.41 and 0.43 (moderate agreement) for depression and anxiety and 0.65 (good agreement) for fatigue. Symptoms were moderate by self-report in 9% for fatigue, 9% for anxiety and 6% for depression and by parent proxy in 9% for fatigue, and 3% for anxiety and depression. None were in the severe range. Mean parent proxy fatigue scores were higher in patients with abnormal ALT (p=0.03) and AST (p=0.03). Mean parent proxy anxiety scores were higher in patients with abnormal ALT (p=0.015) and AST (p=0.005). Mean parent proxy depression scores were higher in patients with abnormal ALT (p=0.03) and AST (p=0.002). There were no significant associations with GGTP, age, or gender or with self-report scores and any variables. Conclusions: PROMIS questionnaires captured symptoms indicating moderate levels of anxiety, fatigue, and depression in 3-10% of LT recipients. Agreement between self and parent proxy report was moderate to good. Elevated liver enzymes predicted behavioral health symptoms by parent proxy report, but not by self-report. Further study to determine relationships between chronic liver injury and behavioral health symptoms following LT is warranted.

CITATION INFORMATION: Mohammad S., Riordan M., Neighbors K., Alonso E. Assessment of Anxiety, Fatigue and Depression in Pediatric Liver Transplant Recipients Using PROMIS Measures: A Pilot Study Am J Transplant. 2017;17 (suppl 3).

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