Impact of preoperative overt hepatic encephalopathy on neurocognitive function after liver transplantation

Abstract

In the current Model for End-Stage Liver Disease allocation system, patients are at risk of suffering repeated episodes of hepatic encephalopathy (HE) while waiting for an orthotopic liver transplantation (OLT); the posttransplantation impact of these episodes has not been well explored. We evaluated the cognitive function and quality of life in a group of OLT recipients (n ϭ 25) who had suffered from overt HE prior to their procedure (HE-PreLT group) and compared their performance to that of a similar group of patients (n ϭ 14) without overt HE (No HE-PreLT group) as well as to controls. Patients were selected from a cohort of 280 patients who underwent OLT during this period; the presence of clinical confounders excluded many of the remaining subjects. Demographic and clinical characteristics were balanced among groups. At an average of 18 months after OLT, we administered 2 neuropsychological batteries [Psychometric Hepatic Encephalopathy Score (PHES) test battery and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)]; a pyschophysiological test (critical flicker frequency); and the SF-36 quality of life score. The HE-PreLT group scored below controls in 5 of 6 cognitive domains tested by RBANS, 3 of 6 PHES subtests, as well as the critical flicker frequency test. The No HE-PreLT group scored below the controls in 1 of the 6 cognitive domains tested by RBANS. The more severe neurocognitive abnormalities seen in the HE-PreLT group did not appear to affect quality of life, as lower values than normative data were only found in 1 of the 8 SF-36 scales. In conclusion, neurocognitive abnormalities were more severe in liver transplant recipients that had suffered from overt HE prior to OLT. Prospective studies of neurocognitive function pre-OLT and post-OLT are needed to fully determine the impact of such abnormalities. Liver Transpl 15:184-192, 2009.

Neuropathological changes in the brain of pigs with acute liver failure

“…This potentially helps explain the persisting neurological complications in patients following liver transplantation [6,[22][23][24]. Furthermore, even though liver transplantation dramatically improves the clinical neurological status, there is evidence in the literature to suggest that minimal HE may persist due to unknown irreversible changes in the brain [25,26]. Therefore full recovery and reversibility of HE following liver transplantation is currently under scrutiny [23].…”

A look at the hepatic encephalopathy in cirrhosis

“…Tuttavia, in alcuni casi, diversi disordini neurologici sono stati riportati anche dopo il trapianto; possibili cause sono: la preesistenza di patologie a carico del sistema nervoso centrale (vascolari, da traumi, da abuso alcolico), il danno ischemico cerebrale intraoperatorio [121], la persistenza di circoli collaterali portosistemici [122,123], la tossicità centrale di immunosoppressori e altri farmaci e, in ultimo, modificazioni e danni non reversibili conseguenti a precenti episodi di EE Overt [119]. L' entità di tali disordini è stata correlata alla severità e al numero di episodi di EE Overt prima del trapianto [124], sebbene siano necessarie ulteriori evidenze per fare sì che la presenza di EE venga presa in considerazione per una più appropriata definizione della priorità in lista d'attesa per trapianto di fegato.…”

Reestablishing Brain Networks in Patients without Overt Hepatic Encephalopathy after Liver Transplantation

“…8 Interestingly, instead of a full reversal, persistent minimal or subclinical HE can be found postLT. 9,10 Therefore, it is questionable whether the brain functional framework that control behavior can recover or be reorganized postLT. Recently, resting-state functional connectivity has been measured using task-independent functional magnetic resonance imaging (MRI) to examine changes in synchronized low frequency oscillations in blood-oxygen-level dependence signal during resting states.…”