1 Department of Neurology, Hannover Medical School, Hannover, Germany.
2 Integrated Research and Treatment Centre Transplantation, Hannover, Germany.
3 Clinic for Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany.
4 Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
Cognitive dysfunction caused by hepatic encephalopathy (HE) improves within the first year after liver transplantation (LT). However, cognitive restitution seems to be incomplete in a subset of patients and after LT a new-onset cognitive decline was described. Data about the long-term development of cognitive function after LT are sparse. This prospective study analyzed whether a history of HE before LT had an impact on the long-term outcome of cognitive function after LT and if patients who underwent LT five years before showed worse cognitive function than healthy controls.
Cognitive function of 34 patients was assessed before, one year and five years after LT by psychometric tests including the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Portosystemic Encephalopathy (PSE)-Syndrome-Test which provides the psychometric hepatic encephalopathy score (PHES). Furthermore, patients completed surveys to assess health related quality of life (HRQOL). Twenty-two additional patients were included after LT. Patients were subdivided by history of HE before LT. Fifty-five healthy subjects adjusted for age and education served as control group.
Before LT, patients performed significantly worse than controls in the psychometric tests (RBANS Total Scale (TS) mean 92.6±13.3 vs 99.9±12, p=0.01: PHES median 0 (25th;75th Percentile -3;1) vs 1 (0;2), p value <0.001). One year after LT, patients with a history of HE still showed cognitive impairment compared to controls (RBANS TS mean 89.8±15.1 vs 99.9±12.0, p value <0.01; PHES median 0 (-2;1.25) vs 1 (0;2), p value =0.03). Five years after LT patients with and without history of HE showed normal cognitive function and improved HRQOL.
HE associated cognitive impairment seems to be reversible within five years after LT.