Cognitive impairment after liver transplantation: residual hepatic encephalopathy or posttransplant encephalopathy?

Linda Skibsted Kornerup,1 Henning Pflugrad,2 Karin Weissenborn,2 Hendrik Vilstrup,1 Gitte Dam11Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus N, Denmark; 2Department of Neurology, Hannover Medical School, Hannover, GermanyAbstract: Liver transplantation (LT) repres...

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Autores principales:	Kornerup LS, Pflugrad H, Weissenborn K, Vilstrup H, Dam G
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	liver transplantation hepatic encephalopathy cirrhosis cognitive impairment Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/e398b7e7d54a4f43bab7a2cbb6d099ab
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spelling	oai:doaj.org-article:e398b7e7d54a4f43bab7a2cbb6d099ab2021-12-02T02:38:01ZCognitive impairment after liver transplantation: residual hepatic encephalopathy or posttransplant encephalopathy?1179-1535https://doaj.org/article/e398b7e7d54a4f43bab7a2cbb6d099ab2019-03-01T00:00:00Zhttps://www.dovepress.com/cognitive-impairment-after-liver-transplantation-residual-hepatic-ence-peer-reviewed-article-HMERhttps://doaj.org/toc/1179-1535Linda Skibsted Kornerup,1 Henning Pflugrad,2 Karin Weissenborn,2 Hendrik Vilstrup,1 Gitte Dam11Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus N, Denmark; 2Department of Neurology, Hannover Medical School, Hannover, GermanyAbstract: Liver transplantation (LT) represents the definitive treatment for end-stage liver disease. Cognitive impairment following LT is frequent, referred to as postliver transplant encephalopathy (PLTE). LT removes the underlying chronic liver disease, and until recently hepatic encephalopathy (HE) was assumed to be fully reversible after LT. However, increasing evidence indicates that some degree of cognitive impairment may be present after LT. To which extent PLTE reflects cognitive impairment caused by residual HE (RHE) or the combined effect of other factors affecting brain function before, during, and after LT is not clarified. None of the available psychometric and neurophysiological tests used for detecting HE is shown to be able to distinguish between etiologies. The available, mostly retrospective, clinical studies indicate a high prevalence of abnormal psychometric tests after LT, and not all seem to recover completely. The patients with earlier HE show the most marked improvements, suggesting that the clinical picture of the early PLTE, in fact, represents RHE. Other early post-LT etiologies for PLTE comprise cerebral ischemia, critical illness encephalopathy, and immunosuppressive therapy. Late-onset etiologies comprise diabetes and hypertension, among others. PLTE regardless of etiology is a worrying issue and needs more attention in the form of mechanistic research, development of diagnostic/discriminative tools, and standardized prospective clinical studies.Keywords: liver transplantation, hepatic encephalopathy, cirrhosis, cognitive impairmentKornerup LSPflugrad HWeissenborn KVilstrup HDam GDove Medical Pressarticleliver transplantationhepatic encephalopathycirrhosiscognitive impairmentDiseases of the digestive system. GastroenterologyRC799-869ENHepatic Medicine: Evidence and Research, Vol Volume 11, Pp 41-46 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	liver transplantation hepatic encephalopathy cirrhosis cognitive impairment Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	liver transplantation hepatic encephalopathy cirrhosis cognitive impairment Diseases of the digestive system. Gastroenterology RC799-869 Kornerup LS Pflugrad H Weissenborn K Vilstrup H Dam G Cognitive impairment after liver transplantation: residual hepatic encephalopathy or posttransplant encephalopathy?
description	Linda Skibsted Kornerup,1 Henning Pflugrad,2 Karin Weissenborn,2 Hendrik Vilstrup,1 Gitte Dam11Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus N, Denmark; 2Department of Neurology, Hannover Medical School, Hannover, GermanyAbstract: Liver transplantation (LT) represents the definitive treatment for end-stage liver disease. Cognitive impairment following LT is frequent, referred to as postliver transplant encephalopathy (PLTE). LT removes the underlying chronic liver disease, and until recently hepatic encephalopathy (HE) was assumed to be fully reversible after LT. However, increasing evidence indicates that some degree of cognitive impairment may be present after LT. To which extent PLTE reflects cognitive impairment caused by residual HE (RHE) or the combined effect of other factors affecting brain function before, during, and after LT is not clarified. None of the available psychometric and neurophysiological tests used for detecting HE is shown to be able to distinguish between etiologies. The available, mostly retrospective, clinical studies indicate a high prevalence of abnormal psychometric tests after LT, and not all seem to recover completely. The patients with earlier HE show the most marked improvements, suggesting that the clinical picture of the early PLTE, in fact, represents RHE. Other early post-LT etiologies for PLTE comprise cerebral ischemia, critical illness encephalopathy, and immunosuppressive therapy. Late-onset etiologies comprise diabetes and hypertension, among others. PLTE regardless of etiology is a worrying issue and needs more attention in the form of mechanistic research, development of diagnostic/discriminative tools, and standardized prospective clinical studies.Keywords: liver transplantation, hepatic encephalopathy, cirrhosis, cognitive impairment
format	article
author	Kornerup LS Pflugrad H Weissenborn K Vilstrup H Dam G
author_facet	Kornerup LS Pflugrad H Weissenborn K Vilstrup H Dam G
author_sort	Kornerup LS
title	Cognitive impairment after liver transplantation: residual hepatic encephalopathy or posttransplant encephalopathy?
title_short	Cognitive impairment after liver transplantation: residual hepatic encephalopathy or posttransplant encephalopathy?
title_full	Cognitive impairment after liver transplantation: residual hepatic encephalopathy or posttransplant encephalopathy?
title_fullStr	Cognitive impairment after liver transplantation: residual hepatic encephalopathy or posttransplant encephalopathy?
title_full_unstemmed	Cognitive impairment after liver transplantation: residual hepatic encephalopathy or posttransplant encephalopathy?
title_sort	cognitive impairment after liver transplantation: residual hepatic encephalopathy or posttransplant encephalopathy?
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/e398b7e7d54a4f43bab7a2cbb6d099ab
work_keys_str_mv	AT kornerupls cognitiveimpairmentafterlivertransplantationresidualhepaticencephalopathyorposttransplantencephalopathy AT pflugradh cognitiveimpairmentafterlivertransplantationresidualhepaticencephalopathyorposttransplantencephalopathy AT weissenbornk cognitiveimpairmentafterlivertransplantationresidualhepaticencephalopathyorposttransplantencephalopathy AT vilstruph cognitiveimpairmentafterlivertransplantationresidualhepaticencephalopathyorposttransplantencephalopathy AT damg cognitiveimpairmentafterlivertransplantationresidualhepaticencephalopathyorposttransplantencephalopathy
_version_	1718402320856776704

Cognitive impairment after liver transplantation: residual hepatic encephalopathy or posttransplant encephalopathy?

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