P: 10 Hepatic Encephalopathy Is Reversible in the Long-term after Liver Transplantation

Abstract

BACKGROUND: Cognitive dysfunction caused by hepatic encephalopathy in patients with acute or chronic liver failure improves within the first year after liver transplantation. However, cognitive restitution seems to be incomplete in a subset of patients. Furthermore, a new-onset cognitive decline after liver transplantation was described. This prospective study analyzed whether a history of hepatic encephalopathy before liver transplantation had an impact on the long-term outcome of cognitive function after liver transplantation and if patients who underwent liver transplantation up to 5 five years before showed worse cognitive function than adjusted healthy controls. METHODS: 34 patients with liver cirrhosis on the waiting list for liver transplantation underwent a psychometric test battery and questionnaires assessing health-related quality of life 3.4 ± 3.1 months (T1) before liver transplantation. Further 33 patients were included directly after liver transplantation. After transplantation all patients (n = 67) underwent psychometric testing and completed questionnaires at 8.9 ± 3.6 months (T2) and at 62.1 ± 12.2 months (T3) thereafter. The psychometric test battery consisted of the Portosystemic Encephalopathy Syndrome-Test which provides the psychometric hepatic encephalopathy score (PHES), the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the Inhibitory Control Test and the Critical Flicker Frequency. All patients were asked to complete the self-reporting questionnaires Hospital Anxiety and Depression Scale, Beck Depression Inventory, Fatigue Impact Scale and Short Form 36 health survey to assess health-related quality of life. Patients were divided into 2 groups: Patients with and without hepatic encephalopathy before liver transplantation. Test results were compared to those of 55 adjusted healthy controls. RESULTS: Patients tested before liver transplantation performed significantly worse than controls in the psychometric tests (RBANS total scale mean 92.6 ± 13.3 vs 99.9 ± 12.0, P < 0.001; PHES median 0 (interquartile range (IQR) −3; 1) vs 1 (IQR 0; 2), P < 0.01). About 1 year after liver transplantation patients with a history of hepatic encephalopathy still showed cognitive impairment compared to controls (RBANS total scale mean 89.5 ± 15.6 vs 99.9 ± 12.0, P = 0.001; PHES median 0 (IQR −2; 1) vs 1 (IQE 0; 2), P < 0.01) while patients without a history of hepatic encephalopathy did not. 5 years after liver transplantation both patient groups did not differ from healthy controls (Table 1). Health-related quality of life improved significantly in both patient groups after transplantation. CONCLUSIONS: Cognitive impairment associated to hepatic encephalopathy seems to be reversible within 5 years after liver transplantation.