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Cognitive Impairment In Liver Transplant Recipients 6 Months Or More After Transplant

K. Berry1, L. Gaynor1, F. Barry1, E. Tsoy1, C. Goode1, R. Wong1, S. Erlhoff1, L. VandeVrede1, K. Possin1, J. C. Lai2

1University of California, San Francisco, San Francisco, CA, 2University of California San Francisco, San Francisco, CA

Meeting: 2022 American Transplant Congress

Abstract number: 9074

Keywords: Age factors, Liver cirrhosis, Liver transplantation, Neurotoxicity

Topic: Clinical Science » Liver » 53 - Liver: Cirrhosis - Portal Hypertension and Other Complications

Session Information

Session Name: Liver: Cirrhosis - Portal Hypertension and Other Complications

Session Type: Poster Abstract

Date: Monday, June 6, 2022

Session Time: 7:00pm-8:00pm

 Presentation Time: 7:00pm-8:00pm

Location: Hynes Halls C & D

*Purpose: Patients with decompensated cirrhosis awaiting liver transplant (LT) exhibit a spectrum of neurocognitive disorders, largely attributed to hepatic encephalopathy (HE) and considered reversible after transplant. Patients with cirrhosis also have risk factors for non-HE causes of cognitive impairment that may persist after LT. We aimed to characterize cognitive impairment ≥ 6 months after LT.

*Methods: We enrolled ambulatory cirrhosis adults awaiting LT. Cognition was assessed ≥ 6 mos post-LT via Brain Health Assessment (BHA): a validated 10-min tablet battery measuring global and domain-specific cognitive functions; performance was reported in z-scores (standard deviations away from demographically-adjusted mean performance in healthy subjects); “cognitive impairment”=z-score ≤-2. Frailty was assessed via Liver Frailty Index (LFI); continuous variable; every 0.1 unit increase=increased frailty. Covariates were collected at pre-LT clinic visit closest to LT (HTN, DM, cirrhosis etiology, MELDNa, HE history, LFI), or date of BHA assessment (age, education, depression severity [Patient Health Questionnaire-9], immunosuppression, time since LT). Descriptive statistics and linear regression were performed.

*Results: 67% of LT recipients had cognitive impairment at a median of 22 mos post-LT. In contrast, prevalence of cognitive impairment in 60 yo in the general population is 6%. Post-LT cognitive impairment was significantly associated with pre-LT frailty. Other classical predictors of dementia like hypertension may also be associated. Our data raise questions about whether pre-LT cognitive dysfunction truly represents HE and whether peri- or post-LT factors lead to cognitive impairment in LT recipients. Assessments of pre-LT frailty may help to identify those at greatest risk for post-LT cognitive dysfunction.

*Conclusions: Cognitive impairment was highly prevalent (67%) in LT recipients a median of 22 months post-LT. In contrast, prevalence of cognitive impairment in 60-year-olds from the general population is 6%; prevalence in 80-year-olds is 25%. Post-LT cognitive impairment was significantly associated with pre-LT frailty, with every 1 unit increase in frailty independently associated with a 1.2 unit decrease in standardized cognitive performance score. Other classical predictors of dementia like hypertension may also be associated. Our data raise questions about whether pre-LT cognitive dysfunction truly represents HE and whether there are peri- or post-LT factors that lead to cognitive impairment in LT recipients. Assessments of pre-LT frailty may help to identify those at greatest risk for post-LT cognitive dysfunction.

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To cite this abstract in AMA style:

Berry K, Gaynor L, Barry F, Tsoy E, Goode C, Wong R, Erlhoff S, VandeVrede L, Possin K, Lai JC. Cognitive Impairment In Liver Transplant Recipients 6 Months Or More After Transplant [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/cognitive-impairment-in-liver-transplant-recipients-6-months-or-more-after-transplant/. Accessed May 30, 2025.

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