Pre-Transplant Overt Hepatic Encephalopathy is Associated with Greater Cognitive Improvement after Liver Transplant
1Neurology, Northwestern University, Chicago, IL, 2Northwestern University, Chicago, IL, 3Surgery, Northwestern University, Chicago, IL
Meeting: 2020 American Transplant Congress
Abstract number: A-108
Keywords: Liver cirrhosis, Liver transplantation, Post-operative complications, Risk factors
Session Information
Session Name: Poster Session A: Liver: Portal Hypertension and Other Complications of Cirrhosis
Session Type: Poster Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: Persistent or residual cognitive impairment following liver transplant is frequently reported yet not well-characterized.
*Methods: Cognitive function was tested in a prospective cohort of patients with liver cirrhosis prior to transplant and at multiple time points following transplant, using NIH Toolbox. Four cognitive domains were tested, including attention, working memory, cognitive flexibility, and processing speed. Trends from pre- to post-transplant cognitive function were examined using mixed models with assessment timepoints entered as a fixed effect. We also examined whether history of pre-transplant overt hepatic encephalopathy (OHE) influenced cognition trajectory by adding an interaction term for OHE and assessment timepoint.
*Results: Twenty-two patients completed both pre- and post-transplant cognitive assessment. Among 22 patients, 4 were assessed at three different post-transplant timepoints, 8 at two timepoints, and 10 at a single timepoint. Post-transplant assessment ranged between 1-28 months. Pre-transplant cognitive function was significantly impaired on all four cognitive domains, with test scores ranging 0.5-1.5 standard deviations below demographic-matched U.S. population norm. Patients with a history of OHE (n=14, 64%) had greater impairment in cognitive domain of attention compared to those without a history of OHE. After transplant, cognitive function significantly improved over time, particularly in tests of attention and processing speed. There was no change in working memory or cognitive flexibility after transplant. Patients with a history of pre-transplant OHE had significantly greater improvement in attention over time, compared to those without a history of OHE.
*Conclusions: Overall, cognitive function improved over time after transplant. Cognitive improvement was observed at as early as one month after transplant, which continued beyond two years after transplant. Certain domains of cognition, such as attention, were more likely to recover after transplant than others such as working memory, especially in those with a history of pre-transplant OHE. Further research is needed to confirm this preliminary finding.
| Cognitive Flexibility | Attention | Working Memory | Processing Speed | Composite | |
| Intercept | 45.54 | 36.42 | 45.63 | 36.51 | 40.93 |
| Assessment Timepoint | 1.47 | 2.78* | 1.50 | 7.99** | 3.37** |
| History of OHE * Assessment Timepoint Interaction | 4.25 | 4.68* | 2.32 | 1.82 | 3.09* |
To cite this abstract in AMA style:
Kim M, Menzel-Smith J, Peipert JD, Reid KJ, Zee P, Ladner DP. Pre-Transplant Overt Hepatic Encephalopathy is Associated with Greater Cognitive Improvement after Liver Transplant [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/pre-transplant-overt-hepatic-encephalopathy-is-associated-with-greater-cognitive-improvement-after-liver-transplant/. Accessed May 9, 2025.« Back to 2020 American Transplant Congress