P: 32 Liver Transplant Is Associated With Improvement in Cognition, Tandem Gait and Risk of Falls

Abstract

BACKGROUND: Cirrhosis is associated with poor health related quality of life (HRQOL), cognitive and physical frailty (CF/PF), that manifest as covert/overt hepatic encephalopathy (CHE/OHE) and with incoordination and falls respectively. Tandem gait (TG; heel-toe) walking is a marker of PF. We aimed to determine the impact of LT on CF, abnormal TG, falls and HRQOL, in decompensated cirrhosis. METHODS: We prospectively enrolled pts from the active LT wait list from 2011–2016. All pts underwent complete neurological examination, cognitive testing by the psychometric hepatic encephalopathy score (PHES), and HRQOL assessment using sickness impact profile (SIP, physical/psychosocial domains). All pts were followed up at 6 & 12 months post-LT at which point repeat testing was done. Cognitive frailty (prior OHE/CHE) & physical frailty (abnormal TD) and falls were analyzed pre/post-LT. RESULTS: 61 pts completed all visits. The median (IQR) time to LT was 54 (16, 112.5) days. Majority were men (51, 84%), with HCV etiology (21, 34%). Pre-LT: Thirty (49%) had abnormal TD, 37 (61%) had CHE, 20 (32.7%) with CHE + abnormal TD, 38 (62%) had prior OHE & 9 (14.7%) had falls. The abnormal vs normal TD pts had similar ages, sex, education level and MELD scores. Comparison showed the abnormal TD group had higher OHE (76% vs 48%, P = 0.03) and worse physical SIP score [24 (12.5, 39) vs 13.8 (3.2, 20.5), P = 0.008]. On multivariable analysis with abnormal TD as dependent variable physical SIP score was significant [OR 1.05 (1.006–1.09), P = 0.02]. On multivariable analysis with CHE+ abnormal TD as dependent variable physical SIP score [OR 1.12 (1.06–1.25), P = 0.02] and PHES scores were significant [OR 0.8 (0.68–0.96), P = 0.02]. Post-LT 6/12 months: Six pts had ACR that was managed with standard treatment and all pts were controlled on calcineurin inhibitors and mycophenolate at post-LT visits. There was a sustained improvement in PHES, SIP scores, falls and TD abnormalities post-LT more at 12 compared to 6 months in all pts (Table 1). Post-LT analysis showed that pts with abnormal pre-LT TD had a worse PHES score at 6 month [−4 (−5, 0) vs −0.5 (−3, 1.25), P = 0.0064] and higher cognitive impairment on PHES [12 (40%) vs 3 (10%), P = 0.007] compared to those with normal pre-LT TD. CONCLUSIONS: After LT, there is a sustained improvement in CF, abnormal TG and HRQOL from 6 through 12 months, which is accompanied by a lower rate of falls.