Hepatic encephalopathy is associated with posttransplant cognitive function and brain volume

Abstract

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 ¼ 0.498, P ¼ 0.013) and poor motor function (r ¼ 0.41, P ¼ 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. Liver Liver transplant candidates often exhibit cognitive disturbances, which are related to the effects of liver failure, the etiology of liver disease (eg, alcoholism), complications of cirrhosis (eg, hyponatremia), and extrahepatic comorbidities (eg, cerebrovascular disease). 1 The most common cause of cognitive impairment appears to be minimal hepatic encephalopathy (HE), which is secondary to liver failure and shares the same pathogenic mechanism as overt HE. Liver transplantation (LT) restores liver function and results in an improvement of minimal HE. 2 However, it is unclear whether minimal HE is fully reversible or

Reestablishing Brain Networks in Patients without Overt Hepatic Encephalopathy after Liver Transplantation

“…This phenomenon corresponds to clinical performances in patients with liver cirrhosis who usually exhibit impaired executive function. 8 In addition, we also observed an improvement in executive function tests and small worldness after LT, further supporting the fundamental findings of graph therapy analysis in HE. Dynamic Evolution of Large-Scale Functional Networks Topology Instead of simplistic mapping of cognitive constructs onto individual brain areas, conjoint function of brain areas is working together as large-scale networks.…”

“…8 Interestingly, instead of a full reversal, persistent minimal or subclinical HE can be found postLT. 9,10 Therefore, it is questionable whether the brain functional framework that control behavior can recover or be reorganized postLT.…”

Brain edema in acute liver failure and chronic liver disease: Similarities and differences

“…This phenomenon also holds true for cirrhotic patients (Garcia-Martinez et al, 2011). Since the development of end-stage liver disease (cirrhosis) requires years of hepatic insults, approximately 80% of cirrhosis cases are diagnosed at 45 or later, with a median age of 56 years (Fleming et al, 2012).…”

Brain Imaging and Hepatic Encephalopathy

“…Garcia-Martinez and colleagues investigated cognitive function, cerebral magnetic resonance spectroscopy and BV post-liver transplantation (59). Posttransplantation, BV was reduced in patients with prior HE, correlating with worse neuropsychiatric score in this group.…”