Neurological disorders in liver transplant candidates: Pathophysiology and clinical assessment

Feltracco, Paolo; Cagnin, Annachiara; Carollo, Cristiana; Barbieri, Stefania; Ori, Carlo

doi:10.1016/j.trre.2017.02.006

Cited by 28 publications

(37 citation statements)

References 136 publications

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“…The LT procedure is furthermore associated with hypotension, blood loss, electrolyte disturbances, and possible postoperative multiorgan failure. All of these factors constitute risk factors for stroke, intracranial or subdural hemorrhage, and, to a lesser extent, subarachnoid hemorrhage . The same patients are also at risk for ischemic stroke for several reasons.…”

Section: Neurological Complications Of Ltmentioning

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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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: Neurological Complications Of Ltmentioning

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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“…Neuropsychiatric symptoms should theoretically improve after LT due to a normal biliary copper excretion. However, several studies have suggested that patients with prior neuropsychiatric symptoms had worse outcomes after LT in terms of postoperative complications and survival and that the total reversibility of their symptoms could not be achieved . The feasibility of extending LT to WD patients with both severe neurological impairments and compensated liver disease, which had remained merely theoretical for decades, has also recently been highlighted …”

mentioning

confidence: 99%

“…However, several studies have suggested that patients with prior neuropsychiatric symptoms had worse outcomes after LT in terms of postoperative complications and survival (16) and that the total reversibility of their symptoms could not be achieved. (12,(17)(18)(19)(20)(21) The feasibility of extending LT to WD patients with both severe neurological impairments and compensated liver disease, which had remained merely theoretical for decades, (22,23) has also recently been highlighted. (24) A multicenter observational study previously analyzed the clinical scenario of LT for WD in Italy between 1985 and 2005.…”

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confidence: 99%

Outcomes of Liver Transplant for Adults With Wilson’s Disease

et al. 2020

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Wilson’s disease (WD) is a rare genetic disorder with protean manifestations. Even if liver transplantation (LT) could represent an effective therapeutic option for patients with end‐stage liver disease, it has remained controversial in the presence of neuropsychiatric involvement. This study aimed to examine the frequency of adult LT for WD in Italy, focusing on the disease phenotype at the time of LT. A retrospective, observational, multicenter study was conducted across Italy exploring the frequency and characteristics of adults transplanted for WD between 2006 and 2016. A total of 29 adult WD patients underwent LT during the study period at 11 Italian LT centers (accounting for 0.4% of all LTs performed), and 27 of them were considered in this analysis (male/female, n = 9/18; age at LT, 29 years [19‐60 years]; median Model for End‐Stage Liver Disease score at LT, 27 [6‐49]). Isolated hepatic phenotype was the indication for LT in 17 (63%) patients, whereas 2 (7%) patients underwent LT for neurological impairment on compensated liver disease. Overall 1‐ and 5‐year patient survival was excellent (88% and 83%, respectively). Neuropsychiatric symptoms early after LT completely recovered in only a few patients. In conclusion, WD remains an uncommon, unusual indication for LT in Italy, displaying good post‐LT graft and patient survival. Because isolated neuropsychiatric involvement represents a rare indication to LT, more data are needed to properly assess the value of LT for WD in this subset of patients.

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“…The occurrence of HM is thought to be due to nitrogenous toxins causing injury to the axon cylinder, neuronal cell bodies, and myelin . Treatment options include ammonia‐lowering agents, benzodiazepine receptor antagonists, high‐dose B vitamins, gabapentin, pentoxifylline, nonabsorbable antibiotics, and portosystemic‐shunt embolization, none of which improves progressive gait disability . In the early stages, liver transplantation is the only treatment modality shown to improve neurological outcomes in this disabling disease (Fig.…”

Section: Discussionmentioning

confidence: 99%