Postoperative cognitive dysfunction after liver transplantation

Aceto, Paola; Perilli, Valter; Lai, Carlo; Ciocchetti, Pierpaolo; Vitale, Francesca; Sollazzi, Liliana

doi:10.1016/j.genhosppsych.2014.12.001

Cited by 35 publications

(30 citation statements)

References 64 publications

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“…inconclusive results, reported that the incidence fluctuated from 0% to 50%. 13 In our study, our results showed that the overall incidence of POCD was 41.4%, which slightly higher than the widely recognized 20-40% for non-cardiac surgery, which is also in line with previous data and our expectations.…”

Section: Incidence Of Pocdsupporting

confidence: 93%

Pathogenic factors of Cognitive Dysfunction after liver transplantation: An observational study

Zhou

Huang

et al. 2020

Preprint

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Background Neurocognitive complications seriously affect long-term health-related quality of life in patients after liver transplantation, but what was it like during the transplant? There has been little related research,so it is very necessary to understand the changes in cognition during the perioperative period. Methods This observational study included patients with end-stage liver disease who are waiting for liver transplantation in our center. We performed the individual cognitive function investigation before and one week after successful surgery,then analyze the changes between them and further explore possible ones that cause perioperative cognitive dysfunction among several factors. Results From December 2018 to November 2019, there are 70 patients completed all the investgation. Compared with preoperative cognitive performance, 29 patients experienced deterioration, 14 patients showed significant improvement, and 27 patients remained unchanged. Multi-factor analysis results showed that, a mean arterial pressure <80 mmHg (p=0.035) during the reperfusion phase, sufentanil dosage <1.5 µg kg -1 (p=0.027), and blood transfusion volume >70 ml kg -1 (p=0.047) were closely related to early postoperative cognitive dysfunction. Conclusions The incidences of deterioration, maintenance, and improvement in cognitive function were 41.6%, 38.4%, and 20%, respectively. Massive blood transfusion, hypotension during the reperfusion phase, insufficient intra-operative analgesia, and lower anesthesia depth may be the independent pathogenic factors for deteriorated cognitive function.

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Section: Incidence Of Pocdsupporting

confidence: 93%

Pathogenic factors of Cognitive Dysfunction after liver transplantation: An observational study

Zhou

Huang

et al. 2020

Preprint

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“…Most patients with neurocognitive symptoms before LT improve during the months following surgery . Nevertheless, some patients show persistent neurocognitive symptoms after LT that are still present even years after the transplant . 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.…”

Section: Neurocognitive Complications After Ltmentioning

confidence: 99%

“…LT may represent a peculiar situation since both patients with ALF and cirrhosis have very high levels of systemic inflammation before LT that could worsen with the additional inflammation associated with the surgical procedure (Table ). This could explain why both the duration of the surgery and its potential complications, infections, and mechanical ventilation before LT have all been reported as risk factors . Furthermore, patients with cirrhosis have been shown to demonstrate long‐lasting cognitive impairment after infection .…”

Section: Hypotheses To Explain Post‐lt Neurocognitive Impairmentmentioning

confidence: 99%

“…However, patients who undergo LT for ALF and patients with cirrhosis without episodes of HE prior to LT also exhibit post‐LT neurological symptoms. This latter situation speaks in favor of a direct adverse effect of either the causal disease, an undiagnosed condition, general anesthesia, surgical procedure, or factors related to the postoperative intensive care unit (ICU) environment . The role of inflammation, which has been described in the ICU setting, could also be a crucial determinant …”

mentioning

confidence: 99%

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

Weiss

Thabut

2019

Liver Transpl

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Orthotopic liver transplantation (LT) remains the only way to definitively cure patients with the most severe liver diseases.Because the survival rate is now fairly high, important questions about neurological sequelae or quality of life after LT have emerged. Indeed, LT represents a peculiar situation because up to 30% of patients present with neurological symptoms after LT compared with only 4% after cardiac transplant and 0.5% after renal transplant. These postoperative neurological symptoms have long been interpreted as sequelae of hepatic encephalopathy (HE). However, postoperative decompensation of an unknown cerebral condition due to the pathophysiology of cirrhosis or undiagnosed neurodegenerative disorders or aging constitute other possibilities that are underrecognized. Some patients who undergo LT for acute liver failure and patients with cirrhosis without episodes of HE and without any previous cerebral alteration also display post-LT neurological symptoms. This latter situation speaks in favor of a direct adverse effect of either general anesthesia, the surgical procedure, or factors related to the postoperative intensive care unit (ICU) environment. The role of inflammation, which has been described in the ICU setting, could also be a crucial determinant. In this review, we will discuss the neurological complications associated with LT, the neurocognitive complications after LT, and how to assess the LT-related neurological or neurocognitive complications. Furthermore, we will review the various hypotheses surrounding post-LT neurocognitive impairment and will conclude with recommendations for future directions.

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“…However, data on its incidence are inconsistent and depend on the procedure. POCD was described in cardiac surgery as coronary artery bypass surgery [2,3], but also in extracardiac surgery [4,5]. Elderly people and patients with coronary heart disease seem to be especially vulnerable for POCD, but as many as 36.6% of surgical patients aged between 18 and 39 years are also affected by POCD [4].…”

Section: Introductionmentioning

confidence: 99%