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

Abstract

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.

Chinese guidelines on management of hepatic encephalopathy in cirrhosis

“…The therapeutic efficacy of internal medicine treatment is not ideal, and recurrent refractory HE accompanied by liver failure is an indication for liver transplantation[93].…”

Liver diseases among Arab world, current state and unmet needs, a scoping review

“…As regard central nervous system affection, there were seventeen publications, most of them studied hepatic encephalopathy from early detection, diagnosis, management and prognosis (288)(289)(290)(291)(292)(293), one article studied minimal hepatic encephalopathy in children (294). Also, sudomotor changes, extrapyramidal manifestations and depression were studied (295)(296)(297).…”

Frequency of Hepatic Encephalopathy in Post liver Transplant Patients

“…In Egypt, Osman et al (2016) found that 10% of postliver transplant patients had encephalopathy [4]. In Egypt, Gad et al (2015) found that 12.6 percent of such individuals had a similar frequency [5].…”