title: Reversibility of minimal hepatic encephalopathy following liver transplantation in Egyptian cirrhotic patients.
abstract: OBJECTIVE
  To evaluate the reversibility of minimal hepatic encephalopathy (MHE) following liver transplantation (LT) in Egyptian cirrhotic patients.
  
  
  METHODS
  This prospective study included twenty patients with biopsy-proven liver cirrhosis listed for LT and twenty age- and sex-matched healthy control subjects. All underwent neuro-psychiatric examination, laboratory investigations, radiological studies and psychometric tests including trail making test A (TMT A), TMT B, digit symbol test and serial dotting test. The psychometric hepatic encephalopathy score (PHES) was calculated for patients to diagnose MHE. Psychometric tests were repeated six months following LT in the cirrhotic patient group.
  
  
  RESULTS
  Before LT, psychometric tests showed highly significant deficits in cirrhotic patients in comparison to controls (P< 0.001). There was a statistically significant improvement in test values in the patient group after LT; however, their values were still significantly worse than those of the controls (P< 0.001). The PHES detected MHE in 16 patients (80%) before LT with a median value of -7 ± 3.5. The median PHES value was significantly improved following LT, reaching -4.5 ± 5 (P< 0.001), and the number of patients with MHE decreased to 11 (55%). The pre-transplant model for end-stage liver disease (MELD) score ≥ 15 was significantly related to the presence of post-transplant MHE (P= 0.005). More patients in whom reversal of MHE was observed had a pre-transplant MELD score < 15.
  
  
  CONCLUSIONS
  Reversal of MHE in cirrhotic patients could be achieved by LT, especially in those with a MELD score < 15.
authors.affiliation: Mahmoud A Osman, Moataz M Sayed, Khaled A Mansour, Shereen A Saleh, Wesam A Ibrahim, Wael A Yousry, Hosam S Elbaz, Reginia N Mikhail, Department of Internal Medicine, Hepatology and Gastroenterology, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt.
authors.forename: Mahmoud A
authors.initials: MA
authors.lastname: Osman
authors.affiliation: Mahmoud A Osman, Moataz M Sayed, Khaled A Mansour, Shereen A Saleh, Wesam A Ibrahim, Wael A Yousry, Hosam S Elbaz, Reginia N Mikhail, Department of Internal Medicine, Hepatology and Gastroenterology, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt.
authors.forename: Moataz M
authors.initials: MM
authors.lastname: Sayed
authors.affiliation: Mahmoud A Osman, Moataz M Sayed, Khaled A Mansour, Shereen A Saleh, Wesam A Ibrahim, Wael A Yousry, Hosam S Elbaz, Reginia N Mikhail, Department of Internal Medicine, Hepatology and Gastroenterology, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt.
authors.forename: Khaled A
authors.initials: KA
authors.lastname: Mansour
authors.affiliation: Mahmoud A Osman, Moataz M Sayed, Khaled A Mansour, Shereen A Saleh, Wesam A Ibrahim, Wael A Yousry, Hosam S Elbaz, Reginia N Mikhail, Department of Internal Medicine, Hepatology and Gastroenterology, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt.
authors.forename: Shereen A
authors.initials: SA
authors.lastname: Saleh
authors.affiliation: Mahmoud A Osman, Moataz M Sayed, Khaled A Mansour, Shereen A Saleh, Wesam A Ibrahim, Wael A Yousry, Hosam S Elbaz, Reginia N Mikhail, Department of Internal Medicine, Hepatology and Gastroenterology, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt.
authors.forename: Wesam A
authors.initials: WA
authors.lastname: Ibrahim
authors.affiliation: Mahmoud A Osman, Moataz M Sayed, Khaled A Mansour, Shereen A Saleh, Wesam A Ibrahim, Wael A Yousry, Hosam S Elbaz, Reginia N Mikhail, Department of Internal Medicine, Hepatology and Gastroenterology, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Abdelhakam
authors.affiliation: Mahmoud A Osman, Moataz M Sayed, Khaled A Mansour, Shereen A Saleh, Wesam A Ibrahim, Wael A Yousry, Hosam S Elbaz, Reginia N Mikhail, Department of Internal Medicine, Hepatology and Gastroenterology, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Bahaa
authors.affiliation: Mahmoud A Osman, Moataz M Sayed, Khaled A Mansour, Shereen A Saleh, Wesam A Ibrahim, Wael A Yousry, Hosam S Elbaz, Reginia N Mikhail, Department of Internal Medicine, Hepatology and Gastroenterology, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt.
authors.forename: Wael A
authors.initials: WA
authors.lastname: Yousry
authors.affiliation: Mahmoud A Osman, Moataz M Sayed, Khaled A Mansour, Shereen A Saleh, Wesam A Ibrahim, Wael A Yousry, Hosam S Elbaz, Reginia N Mikhail, Department of Internal Medicine, Hepatology and Gastroenterology, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt.
authors.forename: Hosam S
authors.initials: HS
authors.lastname: Elbaz
authors.affiliation: Mahmoud A Osman, Moataz M Sayed, Khaled A Mansour, Shereen A Saleh, Wesam A Ibrahim, Wael A Yousry, Hosam S Elbaz, Reginia N Mikhail, Department of Internal Medicine, Hepatology and Gastroenterology, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt.
authors.forename: Reginia N
authors.initials: RN
authors.lastname: Mikhail
authors.affiliation: Mahmoud A Osman, Moataz M Sayed, Khaled A Mansour, Shereen A Saleh, Wesam A Ibrahim, Wael A Yousry, Hosam S Elbaz, Reginia N Mikhail, Department of Internal Medicine, Hepatology and Gastroenterology, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt.
authors.forename: Azza M
authors.initials: AM
authors.lastname: Hassan
authors.affiliation: Mahmoud A Osman, Moataz M Sayed, Khaled A Mansour, Shereen A Saleh, Wesam A Ibrahim, Wael A Yousry, Hosam S Elbaz, Reginia N Mikhail, Department of Internal Medicine, Hepatology and Gastroenterology, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt.
authors.forename: Ehab H
authors.initials: EH
authors.lastname: Elsayed
authors.affiliation: Mahmoud A Osman, Moataz M Sayed, Khaled A Mansour, Shereen A Saleh, Wesam A Ibrahim, Wael A Yousry, Hosam S Elbaz, Reginia N Mikhail, Department of Internal Medicine, Hepatology and Gastroenterology, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt.
authors.forename: Dalia A
authors.initials: DA
authors.lastname: Mahmoud
keywords: Cirrhosis; Liver transplantation; Minimal hepatic encephalopathy; Model for end-stage liver disease score; Psychometric tests