Long-term Outcomes for Liver Transplant Recipients in Terms of Hepatic Encephalopathy

You, Dong Do; Choi, Gyu Seong; Kim, J.M.; Kwon, Choon Hyuck David; Joh, Jae‐Won; Lee, S.-K.

doi:10.1016/j.transproceed.2017.02.054

Cited by 11 publications

(8 citation statements)

References 18 publications

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“…Several data suggest that the metabolic component of HE almost reverses after LT, whereas the structural component may persist . Two main arguments are in favor of possible sequelae of HE: The correlation between neurological impairment and a history of previous bouts of HE …”

Section: Hypotheses To Explain Post‐lt Neurocognitive Impairmentmentioning

confidence: 99%

“…Indeed, even if confounding factors exist, especially the association with systemic inflammation, persistent postoperative cognitive impairment may still be correlated with bouts of HE and their severity . Long‐lasting decompensation due to urea cycle defects, the most frequent inborn error of metabolism responsible for hyperammonemia, is clearly linked to neurological impairment, validating the need for ammonia‐lowering strategies.…”

Section: Hypotheses To Explain Post‐lt Neurocognitive Impairmentmentioning

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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Section: Hypotheses To Explain Post‐lt Neurocognitive Impairmentmentioning

confidence: 99%

Section: Hypotheses To Explain Post‐lt Neurocognitive Impairmentmentioning

confidence: 99%

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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“…The involvement of the brain in liver failure has been an alarming complication for the hepatologist, and it is a decisive factor related to the prognosis of patients with cirrhosis. Concerning LT, the presence of high‐grade HE before transplantation has been associated with a poor outcome as well as other factors related to the pathophysiology of the disease . Even though the clinical spectrum of neurological complications after LT is broad, the presence of neurocognitive involvement is associated with persistent disability and poor quality of life.…”

Section: Discussionmentioning

confidence: 99%

Changes in Cerebral Hemodynamics in Patients With Cirrhosis After Liver Transplantation

Macías-Rodríguez¹,

Ruiz-Margáin²,

Cantú-Brito

et al. 2018

Liver Transpl

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Improvement in cognitive function after orthotopic liver transplantation (LT) has been demonstrated in the acute setting immediately after LT and in acute liver failure. However, the longterm changes in cerebral hemodynamics after LT remain unexplored. Therefore, we aimed to evaluate the longterm changes in cerebral hemodynamics of patients with cirrhosis after LT. In this prospective cohort study, we performed transcranial Doppler ultrasonography (TCD) measuring the pulsatility index (PI), resistance index (RI), and breath-holding index (BHI) to evaluate cerebrovascular structural integrity and reactivity, respectively, in both middle cerebral arteries before and after LT. Neuropsychometric tests and West-Haven criteria were used for hepatic encephalopathy (HE) characterization. Interleukin 6 and tumor necrosis factor α plasma levels were measured. Descriptive statistics and Wilcoxon's test were used. There were 27 patients who were included. Median follow-up after LT was 6 months, mean age before LT was 46.3 ± 10.3 years, the main etiology was hepatitis C virus (59%), and most of the patients were Child-Pugh B (15/27). Model for End-Stage Liver Disease (MELD) score was 16 ± 7.5, MELD-Na was 19.3 ± 7.1, Psychometric Hepatic Encephalopathy Score was -3.48 ± 3.66, and critical flicker fusion (CFF) was 40.28 ± 5.70 Hz. Before LT, 17/27 patients had HE and 11/27 ascites. A decrease of 20.8% and 13.5% in PI and RI was observed after LT (P < 0.001, both), together with an increase in BHI (32.4%, P = 0.122). These changes in cerebral hemodynamics paralleled those in systemic inflammation. Clinical improvement in cognition was observed in all patients with overt HE after LT. In conclusion, these results show a significant improvement in cerebral hemodynamics after LT, obtained through TCD, indicating less arterial cerebral vasoconstriction together with a decrease in systemic inflammation. Changes in cerebral vasoconstriction can be the basis for the improvement in cognitive function after LT in the long term.

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“…This is because several data suggest that LT reverses the metabolic component of HE, but the structural component may persist [36••]. The hypotheses behind this assumption are as follows: hyperammonemia from decompensation due to urea cycle defects can lead to long-term neurological sequelae [34]; correlation between neurological impairment and history of previous episodes of HE [37,38]. In contrast, some studies report that HE is totally reversible and that what is thought to be HE sequelae is a manifestation of competitive brain injuries such as from hyperammonemia [39].…”

Section: Changes In Brain Function After Transplantmentioning

confidence: 99%

Cognitive Function in Liver Transplantation

Albhaisi

Bajaj

2020

Curr Transpl Rep

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Purpose of Review Liver transplantation (LT) remains the only way to cure patients with severe liver diseases. Important questions about neurological sequelae and quality of life after LT have emerged. In this review, we discuss the neurocognitive changes associated with LT and we conclude with recommendations in this regard for patients, caregivers, and physicians. Recent Findings Compared with other solid organ recipients, LT patients tend to have a higher incidence (up to 30%) of neurological complications post-LT. Even in absence of previous episodes of hepatic encephalopathy (HE), some patients display new onset of neurological symptoms post-LT, raising the concern about the role of other factors that may have a direct impact on cognitive function. Summary Different mechanisms have been postulated to explain these postoperative neurological symptoms. They include sequelae of HE, persistent impairment of cognitive function due to cirrhosis, or postoperative decompensation of an unknown or undiagnosed neurodegenerative disorder.

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Long-term Outcomes for Liver Transplant Recipients in Terms of Hepatic Encephalopathy

Cited by 11 publications

References 18 publications

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

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

Changes in Cerebral Hemodynamics in Patients With Cirrhosis After Liver Transplantation

Cognitive Function in Liver Transplantation

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