Cognitive dysfunction and health-related quality of life in long-term liver transplant survivors

Abstract

Although several studies have investigated short-term effects of liver transplantation on cognitive function and health-related quality of life, there have been no studies looking at long-term effects. Patients who received a single liver transplant at St James's University Hospital (Leeds, UK) before October 1, 1991, were invited to participate in this cross-sectional study. Cognitive function was assessed using the Mini-Mental State Examination, the Rey Auditory Verbal Learning Test, trail-making tests, the Stroop test, and the Benton Visual Retention Test. Anxiety and depression were documented using the Hospital Anxiety and Depression Scale. Health-related quality of life was assessed using the EuroQol. Twenty-five healthy volunteers acted as controls. Thirty-six patients had undergone transplantation before October 1, 1991. Thirteen patients (36%) had died, 6 patients had received more than one transplant, 2 patients did not speak English, and 3 patients did not want to participate, leaving 12 patients included in the study. Patients scored significantly lower on measures of health-related quality of life than healthy controls, but there were no differences in levels of anxiety or depression. Patients scored significantly lower than controls across a wide range of cognitive functions, suggesting global cognitive impairment. We show that patients who survive for more than 10 years after liver transplantation have significant cognitive dysfunction and poor health-related quality of life. Whether these patients never return to normal after transplantation or whether they experience an increased rate of decline in cognitive function and health-related quality of life is uncertain and requires further study. O ne-year survival rates for liver transplantation now exceed 90% in some centers and soon are expected to exceed 70% at 10 years. 1 Many studies have looked at short-term effects of liver transplantation, but very few are looking at long-term effects. 2,3 To our knowledge, no study has explored cognitive function or health-related quality of life in extremely long-term survivors of liver transplantation (Ͼ10 years). One of the few studies looking at long-term outcome followed up patients for up to 5 years and concluded that improvements seen in health-related quality of life continued to this time. 4 Another similar cross-sectional study by De Bona et al 3 managed to recruit seven patients who had received their transplants 49 to 60 months previously. They showed there was an initial improvement in health-related quality of life and psychological distress, followed approximately 6 months later by a further decline, which then began to resolve again after approximately 36 months. These studies did not have patients who underwent transplantation more than 5 years previously.It has been shown that cognitive deficits detectable in patients with end-stage liver failure improve after transplantation, 5-8 but whether this improvement is maintained in the long term is unknown.Cognitive problems faced by these patie...

A Long-Term Study of Changes in the Volume of Brain Ventricles and White Matter Lesions After Successful Liver Transplantation

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Systematic Review: Health-State Utilities in Liver Disease: A Systematic Review

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