A long-term study of changes in the volume of brain ventricles and white matter lesions after successful liver transplantation.
BACKGROUND
A prolonged survival in liver transplant recipients due to a better management exposes them to multiple factors that can impair neurologic function in the long term.


METHODS
Twenty-two patients were studied by brain magnetic resonance and completed a neuropsychologic assessment shortly before liver transplant, 6 to 12 months after (short term), and 6 to 9 years (long term) after liver transplant. Thirteen healthy controls matched by age were studied in parallel.


RESULTS
An enlargement in the ventricular size (an indirect measure of brain volume) was observed in the short term (+8%) and in the long term after liver transplant (+22%); the size of ventricles was larger than in healthy controls. In addition, a progression in the volume of focal T2 white matter lesions (an index of small vessel cerebrovascular disease) was detected in the long term (+49%) and was related to vascular risk factors in those with larger increases (>12.5% per year). Neuropsychologic function showed a significant improvement after liver transplant and remained stable in the long term, except for memory loss in those patients with larger increases in white matter lesions.


CONCLUSIONS
Improvement in neuropsychologic function after successful liver transplant can be demonstrated up to 9 years. However, these patients experience a progressive accumulation of focal T2 brain lesions and show a smaller brain volume than controls, which can be related to their previous cirrhosis. A good management to minimize brain injury before transplantation and an accurate treatment of vascular risk factors may be important to prevent consequences on cognitive function.
García Martínez
Rita
R
Servei de Medicina Interna-Hepatologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Rovira
Alex
A
Alonso
Juli
J
Aymerich
F Xavier
FX
Huerga
Elena
E
Jacas
Carlos
C
Simón-Talero
Macarena
M
Vargas
Víctor
V
Córdoba
Juan
J
D000368:Aged; D001921:Brain / Q000033:anatomy & histology*; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D002552:Cerebral Ventricles / Q000033:anatomy & histology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000601:surgery; D017093:Liver Failure / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation / Q000502:physiology* / Q000523:psychology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D009929:Organ Size; D011184:Postoperative Period; D012016:Reference Values; D013997:Time Factors