Hepatic encephalopathy is associated with posttransplant cognitive function and brain volume

Authors

  • Rita Garcia-Martinez,

    1. Internal Medicine Hepatology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
    2. Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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  • Alex Rovira,

    1. Magnetic Resonance Unit (I.D.I.), Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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  • Juli Alonso,

    1. Magnetic Resonance Unit (I.D.I.), Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
    2. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
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  • Carlos Jacas,

    1. Neuropsychology Unit, Psychiatric Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
    2. Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
    3. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
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  • Macarena Simón-Talero,

    1. Internal Medicine Hepatology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
    2. Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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  • Laia Chavarria,

    1. Internal Medicine Hepatology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
    2. Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
    3. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
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  • Víctor Vargas,

    1. Internal Medicine Hepatology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
    2. Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
    3. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
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  • Juan Córdoba

    Corresponding author
    1. Internal Medicine Hepatology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
    2. Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
    3. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
    • Servei de Medicina Interna-Hepatologia, Hospital General Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, Barcelona 08035, Spain
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    • Telephone: 0034932746140; FAX: 0034932746068


  • This project was funded by grants FIS 05/0226 and 07/0641. CIBERehd is supported by Instituto de Salud Carlos III. R.G.-M. is the recipient of grant CM07/00109.

Abstract

Hepatic encephalopathy (HE) is a common complication of cirrhosis that is associated with brain atrophy and may participate in impaired cognitive function after liver transplantation. This study analyzes the relationship of HE with cognitive function and brain volume after transplantation. A total of 52 consecutive patients with cirrhosis (24 alcohol abuse, 24 prior HE, 14 diabetes mellitus) completed a neuropsychological assessment before liver transplantation and again, 6 to 12 months after transplantation. In 24 patients who underwent the posttransplant assessment, magnetic resonance imaging was performed in addition, with measurement of brain volume and relative concentration of N-acetylaspartate (NAA) and creatine/phosphocreatine (Cr), a neuronal marker, by magnetic resonance spectroscopy. Neuropsychological assessment prior to transplantation identified minimal HE in 28 patients. All cognitive indexes improved after liver transplantation, but 7 patients (13%) showed persistent mild cognitive impairment. Global cognitive function after transplantation was poorer in patients with the following variables before liver transplantation: alcohol etiology, diabetes mellitus, and HE. Brain volume after transplantation was smaller in patients with prior HE. Brain volume correlated to NAA/Cr values (r = 0.498, P = 0.013) and poor motor function (r = 0.41, P = 0.049). In conclusion, the association of HE with cognitive function and brain volume suggests that having experienced HE before liver transplantation impairs the posttransplantation neurological outcome. Liver Transpl 17:38–46, 2011. © 2011 AASLD.

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