Hepatic encephalopathy before and neurological complications after liver transplantation have no impact on the employment status 1 year after transplantation

Abstract

AIMTo investigate the impact of hepatic encephalopathy before orthotopic liver transplantation (OLT) and neurological complications after OLT on employment after OLT.METHODSOne hundred and fourteen patients with chronic liver disease aged 18-60 years underwent neurological examination to identify neurological complications, neuropsychological tests comprising the PSE-Syndrome-Test yielding the psychometric hepatic encephalopathy score, the critical flicker frequency and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), completed a questionnaire concerning their occupation and filled in the short form 36 (SF-36) to assess health-related quality of life before OLT and 12 mo after OLT, if possible. Sixty-eight (59.6%) patients were recruited before OLT, while on the waiting list for OLT at Hannover Medical School [age: 48.7 ± 10.2 years, 45 (66.2%) male], and 46 (40.4%) patients were included directly after OLT.RESULTSBefore OLT 43.0% of the patients were employed. The patients not employed before OLT were more often non-academics (employed: Academic/non-academic 16 (34.0%)/31 vs not employed 10 (17.6%)/52, P = 0.04), had more frequently a history of hepatic encephalopathy (HE) (yes/no; employed 15 (30.6%)/34 vs not employed 32 (49.2%)/33, P = 0.05) and achieved worse results in psychometric tests (RBANS sum score mean ± SD employed 472.1 ± 44.5 vs not employed 443.1 ± 56.7, P = 0.04) than those employed. Ten patients (18.2%), who were not employed before OLT, resumed work afterwards. The patients employed after OLT were younger [age median (range, min-max) employed 47 (42, 18-60) vs not employed 50 (31, 29-60), P = 0.01], achieved better results in the psychometric tests (RBANS sum score mean ± SD employed 490.7 ± 48.2 vs not employed 461.0 ± 54.5, P = 0.02) and had a higher health-related quality of life (SF 36 sum score mean ± SD employed 627.0 ± 138.1 vs not employed 433.7 ± 160.8; P < 0.001) compared to patients not employed after OLT. Employment before OLT (P < 0.001), age (P < 0.01) and SF-36 sum score 12 mo after OLT (P < 0.01) but not HE before OLT or neurological complications after OLT were independent predictors of the employment status after OLT.CONCLUSIONHE before and neurological complications after OLT have no impact on the employment status 12 mo after OLT. Instead younger age and employment before OLT predict employment one year after OLT.

Cerebral metabolite alterations in patients with posttransplant encephalopathy after liver transplantation

“…The patients included into this analysis took part in a long-term follow up study of patients after liver transplantation performed at Hannover Medical School, Hannover, Germany. For a detailed description of the patient cohort see [14].…”

Neurological Complications Occurring After Liver Transplantation: Role of Risk Factors, Hepatic Encephalopathy, and Acute (on Chronic) Brain Injury

“…For neuropsychological testing, treatment with CNIs presents a bias that may not be easily overcome in these studies. Nevertheless, a recent report found that although the dosage of CNIs affected neuropsychological testing, there was no impact on brain atrophy as assessed by brain MRI …”

“…Although two‐thirds of patients with cirrhosis exhibit neurocognitive abnormalities prior to LT, 20% still show impairment long after the procedure, despite normal liver function tests and the absence of HE before LT. Although CNIs have been implicated as possible contributors, they cannot account for all the reported abnormalities . Because the gross neurological examination is frequently normal, neurocognitive‐associated complications are usually considered if quality of life is affected or after concerns are raised by the caregivers.…”

Hepatic Encephalopathy and Liver Transplantation: The Past, Present, and Future Toward Equitable Access

“…(73,79) Second, based on the underlying etiology for the cognitive dysfunction, patients could take longer to demonstrate selfefficacy, (80) although this does not always translate to loss of employment and income. (81) Last, those with serious neurological complications, including encephalopathies, seizures, and central pontine myelinolysis, have a higher morbidity than those without them. (71,82) To conclude, the cognitive deficits associated with CHE and OHE are partly reversed after LT.…”