Minimal Hepatic Encephalopathy

Mattarozzi, Katia; Stracciari, Andrea; Vignatelli, Luca; D’Alessandro, Roberto; Morelli, Cristina; Guarino, Maria

doi:10.1001/archneur.61.2.242

Cited by 66 publications

(19 citation statements)

References 21 publications

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“…This is also in agreement with Mattarozzi et al[20] and Montagnese et al[21]. More patients with a pre-transplant MELD score > 15 experienced pre- and post-transplant MHE.…”

Section: Discussionsupporting

confidence: 92%

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Reversibility of minimal hepatic encephalopathy following liver transplantation in Egyptian cirrhotic patients

Osman

Sayed

Mansour

et al. 2016

WJH

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AIMTo evaluate the reversibility of minimal hepatic encephalopathy (MHE) following liver transplantation (LT) in Egyptian cirrhotic patients.METHODSThis 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.RESULTSBefore 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.CONCLUSIONReversal of MHE in cirrhotic patients could be achieved by LT, especially in those with a MELD score < 15.

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“…This is also in agreement with Mattarozzi et al[20] and Montagnese et al[21]. More patients with a pre-transplant MELD score > 15 experienced pre- and post-transplant MHE.…”

Section: Discussionsupporting

confidence: 92%

“…The significant improvement of the patients’ MELD score after LT agrees with Lin et al[10] and Mattarozzi et al[20]. …”

Section: Discussionsupporting

confidence: 89%

Reversibility of minimal hepatic encephalopathy following liver transplantation in Egyptian cirrhotic patients

Osman

Sayed

Mansour

et al. 2016

WJH

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“…In addition, although the degree of portal hypertension in patients with biliary atresia with their native livers was difficult to quantify based on recorded physical findings, it is expected that many had a degree of portal hypertension, which might contribute to subclinical or minimal hepatic encephalopathy. In cirrhotic adults with evidence of minimal hepatic encephalopathy on neurocognitive testing, abnormalities improve, but are not completely reversed after liver transplantation (26, 27). Therefore, this may suggest that cognitive deficits associated with portal hypertension in the pre-transplant period in patients with biliary atresia may still contribute to HRQOL in post-transplant follow-up.…”

Section: Discussionmentioning

confidence: 99%

Health Related Quality of Life in Patients with Biliary Atresia Surviving with their Native Liver

Sundaram

Alonso

Haber

et al. 2013

The Journal of Pediatrics

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Objectives To quantify health related quality of life (HRQOL) of patients with biliary atresia with their native livers and compare them with healthy children and patients with biliary atresia post-liver transplant (LT) and to examine the relationship between HRQOL and medical variables. Study design A cross-sectional HRQOL study of patients with biliary atresia with their native livers (ages 2-25 years) was conducted and compared with healthy and post-LT biliary atresia samples using PedsQL™ 4.0 child self and parent proxy reports, a validated measure of physical/psychosocial functioning. Results 221 patients with biliary atresia with native livers (54% female, 67% white) were studied. patient self and parent proxy reports showed significantly poorer HRQOL than healthy children across all domains (p < 0.001), particularly in emotional and psychosocial functioning. Child self and parent proxy HRQOL scores from patients with biliary atresia with their native livers and post-LT biliary atresia were similar across all domains (p=NS). Child self and parent proxy reports showed moderate agreement across all scales, except social functioning (poor to fair agreement). On multivariate regression analysis, black race and elevated total bilirubin were associated with lower Total and Psychosocial HRQOL summary scores. Conclusions HRQOL in patients with biliary atresia with their native livers is significantly poorer than healthy and similar to post-LT biliary atresia children. These findings identify significant opportunities to optimize the overall health of patients with biliary atresia.

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“…Liver transplantation (LT) can correct liver function, resulting in an improvement symptom of MHE. [4] However, at least during the first 2 years after LT, some cognitive defects seem to persist to some degree. [5] Thus, whether complete reversibility of brain edema, cognitive deficits, and their associated imaging can be achieved remains an open question.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal Brain White Matter Alterations in Minimal Hepatic Encephalopathy before and after Liver Transplantation

Lin

Chou²,

Chen

et al. 2014

PLoS ONE

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Cerebral edema is the common pathogenic mechanism for cognitive impairment in minimal hepatic encephalopathy. Whether complete reversibility of brain edema, cognitive deficits, and their associated imaging can be achieved after liver transplantation remains an open question. To characterize white matter integrity before and after liver transplantation in patients with minimal hepatic encephalopathy, multiple diffusivity indices acquired via diffusion tensor imaging was applied. Twenty-eight patients and thirty age- and sex-matched healthy volunteers were included. Multiple diffusivity indices were obtained from diffusion tensor images, including mean diffusivity, fractional anisotropy, axial diffusivity and radial diffusivity. The assessment was repeated 6–12 month after transplantation. Differences in white matter integrity between groups, as well as longitudinal changes, were evaluated using tract-based spatial statistical analysis. Correlation analyses were performed to identify first scan before transplantation and interval changes among the neuropsychiatric tests, clinical laboratory tests, and diffusion tensor imaging indices. After transplantation, decreased water diffusivity without fractional anisotropy change indicating reversible cerebral edema was found in the left anterior cingulate, claustrum, postcentral gyrus, and right corpus callosum. However, a progressive decrease in fractional anisotropy and an increase in radial diffusivity suggesting demyelination were noted in temporal lobe. Improved pre-transplantation albumin levels and interval changes were associated with better recoveries of diffusion tensor imaging indices. Improvements in interval diffusion tensor imaging indices in the right postcentral gyrus were correlated with visuospatial function score correction. In conclusion, longitudinal voxel-wise analysis of multiple diffusion tensor imaging indices demonstrated different white matter changes in minimal hepatic encephalopathy patients. Transplantation improved extracellular cerebral edema and the results of associated cognition tests. However, white matter demyelination may advance in temporal lobe.

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Minimal Hepatic Encephalopathy

Cited by 66 publications

References 21 publications

Reversibility of minimal hepatic encephalopathy following liver transplantation in Egyptian cirrhotic patients

Reversibility of minimal hepatic encephalopathy following liver transplantation in Egyptian cirrhotic patients

Health Related Quality of Life in Patients with Biliary Atresia Surviving with their Native Liver

Longitudinal Brain White Matter Alterations in Minimal Hepatic Encephalopathy before and after Liver Transplantation

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