Neurologic complications occur following 26% of liver transplants. A higher proportion of patients who received transplants for alcoholic liver disease and primary biliary cirrhosis experienced neurologic complications than those receiving transplants for other reasons. Patients who experience a neurologic problem spend longer in hospital and have a poorer outcome.

Although several studies have investigated short-term effects of liver transplantation on cognitive function and health-related quality of life, there have been no studies looking at long-term effects. Patients who received a single liver transplant at St James's University Hospital (Leeds, UK) before October 1, 1991, were invited to participate in this cross-sectional study. Cognitive function was assessed using the Mini-Mental State Examination, the Rey Auditory Verbal Learning Test, trail-making tests, the Stroop test, and the Benton Visual Retention Test. Anxiety and depression were documented using the Hospital Anxiety and Depression Scale. Health-related quality of life was assessed using the EuroQol. Twenty-five healthy volunteers acted as controls. Thirty-six patients had undergone transplantation before October 1, 1991. Thirteen patients (36%) had died, 6 patients had received more than one transplant, 2 patients did not speak English, and 3 patients did not want to participate, leaving 12 patients included in the study. Patients scored significantly lower on measures of health-related quality of life than healthy controls, but there were no differences in levels of anxiety or depression. Patients scored significantly lower than controls across a wide range of cognitive functions, suggesting global cognitive impairment. We show that patients who survive for more than 10 years after liver transplantation have significant cognitive dysfunction and poor health-related quality of life. Whether these patients never return to normal after transplantation or whether they experience an increased rate of decline in cognitive function and health-related quality of life is uncertain and requires further study. O ne-year survival rates for liver transplantation now exceed 90% in some centers and soon are expected to exceed 70% at 10 years. 1 Many studies have looked at short-term effects of liver transplantation, but very few are looking at long-term effects. 2,3 To our knowledge, no study has explored cognitive function or health-related quality of life in extremely long-term survivors of liver transplantation (Ͼ10 years). One of the few studies looking at long-term outcome followed up patients for up to 5 years and concluded that improvements seen in health-related quality of life continued to this time. 4 Another similar cross-sectional study by De Bona et al 3 managed to recruit seven patients who had received their transplants 49 to 60 months previously. They showed there was an initial improvement in health-related quality of life and psychological distress, followed approximately 6 months later by a further decline, which then began to resolve again after approximately 36 months. These studies did not have patients who underwent transplantation more than 5 years previously.It has been shown that cognitive deficits detectable in patients with end-stage liver failure improve after transplantation, 5-8 but whether this improvement is maintained in the long term is unknown.Cognitive problems faced by these patie...

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Reclassification of salt-water Bdellovibrio sp. as Bacteriovorax marinus sp. nov. and Bacteriovorax litoralis sp. nov.Bdellovibrios are unique, predatory bacteria with an intraperiplasmic growth and multiplication phase within their prey, which consists of many Gram-negative bacteria. Until recently, all bacteria that exhibited these traits were included in the genus Bdellovibrio. However, analysis of 16S rDNA sequences and other studies have demonstrated substantial genotypic, phenotypic and ecotypic diversity among the organisms in this genus (Baer et al., 2000;Snyder et al., 2002). This has resulted in reclassification of Bdellovibrio stolpii and Bdellovibrio starrii into the newly constructed genus Bacteriovorax (Baer et al., 2000). In this study, examination of marine isolates of Bdellovibrio (designated SJ T , AQ and JS5 T ) has revealed them to be related more closely to the newly designated genus Bacteriovorax. Phylogenetic analysis of 16S rRNA gene sequences revealed that marine isolates SJ T , AQ and JS5 T clustered in a separate clade from Bdellovibrio bacteriovorus 100 T as part of the clade that contains Bacteriovorax spp., indicating a much closer taxonomic relationship to the latter. DNA-DNA hybridization experiments also demonstrated <5 % similarity between Bdellovibrio bacteriovorus 100 T and the marine isolates. Distinct differences between the salt-water group and Bdellovibrio spp. were also observed by determination of DNA G+C content, salinity growth testing and antibiotic sensitivity analysis. On the basis of the results from the studies described above, it is proposed that marine isolates SJ T (=ATCC BAA-682 T =DSM 15412 T ) and JS5 T (=ATCC BAA-684 T =DSM 15409 T ) should be classified within the genus Bacteriovorax as the type strains of Bacteriovorax marinus sp. nov. and Bacteriovorax litoralis sp. nov., respectively.

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