Hepatic Encephalopathy Is Reversible in the Long Term After Liver Transplantation

Abstract

Cognitive dysfunction caused by hepatic encephalopathy (HE) improves within the first year after liver transplantation (LT). However, cognitive restitution seems to be incomplete in a subset of patients and after LT a new‐onset cognitive decline was described. Data about the longterm development of cognitive function after liver transplantation (LT) are sparse. This prospective study analyzed whether a history of hepatic encephalopathy (HE) before LT had an impact on the longterm outcome of cognitive function after LT and if patients who underwent LT 5 years earlier showed worse cognitive function than healthy controls. The cognitive function of 34 patients was assessed before LT and at 1 year and 5 years after LT by psychometric tests, including the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the portosystemic encephalopathy syndrome test, which provides the psychometric hepatic encephalopathy score (PHES). Furthermore, patients completed surveys to assess health‐related quality of life (HRQOL). An 22 additional patients were included after LT. Patients were subdivided by having a history of HE before LT. The control group consisted of 55 healthy patients adjusted for age and education. Before LT, patients performed significantly worse than controls in the psychometric tests: RBANS Total Scale (TS), mean ± standard deviation (SD), 92.6 ± 13.3 versus 99.9 ± 12.0, P = 0.01; and PHES, median (interquartile range [IQR]), 0 (−3 to 1) versus 1 (0‐2), P < 0.001. At 1 year after LT, patients with a history of HE still showed cognitive impairment compared with controls: RBANS TS, mean ± SD, 89.8 ± 15.1 versus 99.9 ± 12.0, P < 0.01; and PHES, median (IQR), 0 (−2 to 1.25) versus 1 (0‐2), P = 0.03. At 5 years after LT, patients with and without a history of HE showed normal cognitive function and improved HRQOL. In conclusion, HE‐associated cognitive impairment seems to be reversible within 5 years after LT.

The Role of Intestinal Bacteria and Gut–Brain Axis in Hepatic Encephalopathy

“…It is very challenging to give accurate clinical diagnosis before overt symptoms set in, thus, leading to a decrease in the quality of life and survival time ( Bajaj, 2008 ; Wijdicks, 2016 ). Learning ability of HE is not completely reversible and new cognitive decline occurs after treatment in some patients ( Riggio et al, 2011 ; Hopp et al, 2019 ).…”

Cognitive Impairment After Resolution of Hepatic Encephalopathy: A Systematic Review and Meta-Analysis

“…Some of these studies assessed cognition on these two groups of patients after LT and were included in a subsequent analysis. Of those, three studies (Sotil et al, 2009;Garcia-Martinez et al, 2011;Hopp et al, 2019) were included only in the post-LT due to lack of sufficient pre-LT data concerning neuropsychological tests scores for patients with and without a history of OHE specifically.…”

“…The post-LT analysis included six studies totaling 151 patients with and 156 patients without a history of OHE. For studies evaluating the effect of overt HE after LT, the time after LT varied from 6 months (Acharya et al, 2017) to up to 5 years (Hopp et al, 2019).…”

Hepatic encephalopathy: Novel insights into classification, pathophysiology and therapy

“…Whether neurological complications observed in LT recipients are residual symptoms from a history of HE (pre-LT) or newly developed perioperatively (HE-influenced) or related to a comorbidity is difficult to define accurately. Having said this, a recent study reported a recovery of brain function in patients followed-up long-term (>5 years) post-LT. 150…”