Hepatic encephalopathy is associated with posttransplant cognitive function and brain volume.
Hepatic encephalopathy (HE) is a common complication of cirrhosis that is associated with brain atrophy and may participate in impaired cognitive function after liver transplantation. This study analyzes the relationship of HE with cognitive function and brain volume after transplantation. A total of 52 consecutive patients with cirrhosis (24 alcohol abuse, 24 prior HE, 14 diabetes mellitus) completed a neuropsychological assessment before liver transplantation and again, 6 to 12 months after transplantation. In 24 patients who underwent the posttransplant assessment, magnetic resonance imaging was performed in addition, with measurement of brain volume and relative concentration of N-acetylaspartate (NAA) and creatine/phosphocreatine (Cr), a neuronal marker, by magnetic resonance spectroscopy. Neuropsychological assessment prior to transplantation identified minimal HE in 28 patients. All cognitive indexes improved after liver transplantation, but 7 patients (13%) showed persistent mild cognitive impairment. Global cognitive function after transplantation was poorer in patients with the following variables before liver transplantation: alcohol etiology, diabetes mellitus, and HE. Brain volume after transplantation was smaller in patients with prior HE. Brain volume correlated to NAA/Cr values (r = 0.498, P = 0.013) and poor motor function (r = 0.41, P = 0.049). In conclusion, the association of HE with cognitive function and brain volume suggests that having experienced HE before liver transplantation impairs the posttransplantation neurological outcome.
Internal Medicine Hepatology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Rita
R
Garcia-Martinez
Alex
A
Rovira
Juli
J
Alonso
Carlos
C
Jacas
Macarena
M
Simón-Talero
Laia
L
Chavarria
Víctor
V
Vargas
Juan
J
Córdoba
D000328:Adult; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D001284:Atrophy; D001921:Brain / Q000378:metabolism / Q000473:pathology*; D016009:Chi-Square Distribution; D003071:Cognition; D003072:Cognition Disorders / Q000209:etiology* / Q000473:pathology / Q000523:psychology; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology* / Q000473:pathology / Q000523:psychology; D006801:Humans; D016014:Linear Models; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology / Q000523:psychology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D009048:Motor Skills; D009483:Neuropsychological Tests; D009929:Organ Size; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome
D001224:Aspartic Acid; C000179:N-acetylaspartate