Clinical and radiological impact of liver transplantation for brain in cirrhosis patients without hepatic encephalopathy

Postoperative cognitive dysfunction after liver transplantation

“…The type cognitive assessment throughout the studies includes several components that are affected in MHE, such as attention, concentration, psychomotor speed and verbal and visuospatial short-term memory. Therefore, most of the studies consider also the persistence or worsening of preexisting cognitive deficits as POCD [27][28][29]22,[37][38][39][40][41][42], in accordance with the statement that successful LT should remove HE [27,31,32]. MHE predicts OHE [43], but it is often clinically missed [44].…”

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

“…However, several data also suggest persistent cerebral abnormalities after LT. Standard MRI sequences can provide evidence of reduced brain volume and a decrease in the MRS N ‐acetylaspartate (NAA)/creatine (Cr) ratio, both of which suggest the presence of fixed brain lesions and brain atrophy . In some patients following LT, preliminary DTI data have identified possible persistent decreased fractional anisotropy (FA) that confirms axonal degeneration, and functional MRI has shown persistent altered functioning . However, the latter data should be confirmed with other studies.…”

“…On the one hand, post‐LT improvement has been shown in the setting of HE on the basis of EEG and PET scan results . On the other hand, MRI studies that use standard sequences, magnetic resonance spectroscopy (MRS), diffusion tensor imaging (DTI), and functional MRI (Table ) can show both improvement in cerebral abnormalities that were present prior to LT because of HE (see Table for review) and persistent abnormalities after LT . Spontaneous T 1 ‐weighted sequence basal ganglia hypersignals, white matter changes in the corticospinal tract, magnetization transfer ratio (MTR), and the HE profile on MRS normalize months after LT .…”

“…MRS peaks can normalize as early as 3 months after LT (Table ). Despite limited data from DTI, it appears that mean diffusivity (MD) decreases after LT, suggesting a correction of vasogenic edema with the normalization of liver function . Only scarce data are available from functional MRI, though what is available also suggests an improvement in the functioning of the previously altered networks after LT .…”

Neuropsychological functioning among individuals infected with hepatitis C: a comparison of pre- and post-transplant performance

“…However, cognitive functioning post-liver transplant is less well characterized. A handful of studies assessed cognitive functions of liver transplant recipients (Commander, Neuberger & Dean, 1992;Elliott, Frith, Pairman, Jones & Newton, 2011;Hockerstedt et al, 1992;Ishihara et al, 2013;Lewis & Howdle, 2003;Mattarozzi et al, 2004;Mechtcheriakov et al, 2004;Miller-Matero et al, 2014;Moore, Mc & Burrows, 2000;Pantiga et al, 2003;Riether, Smith, Lewison, Cotsonis & Epstein, 1992;Sotil, Gottstein, Ayala, Randolph & Blei, 2009;Tarter, Switala, Arria, Plail & Van Thiel, 1990); however, only seven examined changes between pre-and posttransplant functioning using objective cognitive measures (Hockerstedt et al, 1992;Ishihara et al, 2013;Mattarozzi et al, 2004;Mechtcheriakov et al, 2004;Moore et al, 2000;Riether et al, 1992;Tarter et al, 1990). With the exception of one (Mechtcheriakov et al, 2004), these studies reported significant improvements in most cognitive domains studied, but four out of seven found that cognitive functioning of transplant recipients did not return to the level of the healthy controls (Hockerstedt et al, 1992;Mechtcheriakov et al, 2004;Moore et al, 2000;Tarter et al, 1990).…”