*Purpose: Liver transplant (LT) recipients may experience global or domain-specific cognitive impairment (CI) (e.g., attention and memory) post-transplant due to multiple potential factors such as pre-transplant hepatic encephalopathy, brain ischemia during surgery, or immunosuppressant treatment. However, current research has been limited to examining the impacts of LT on reversing pre-transplant CI, resulting in an insufficient understanding of lingering post-transplant CI in this population. This study examined differences in global and domain-specific cognition by demographics and clinical characteristics of LT recipients.

*Methods: This secondary data analysis included adult LT recipients who had a functioning LT for at least 6 months. The Montreal Cognitive Assessment (MoCA) was used to assess cognition. MoCA scores range from 0 to 30 and are typically categorized as dementia (<17), moderate CI (17-21), mild CI (22-25), and normal (>=26). Four cognitive domains (Visuospatial/Executive functioning, Memory, Attention, and Language) were calculated based on the work of Vogel et al. (2015). T-tests or Mann-Whitney tests, depending on normality, and Kruskal-Wallis tests were used to examine differences in cognition by demographics and clinical characteristics.

*Results: Data from 107 LT recipients (mean age 61.0±11.9, 60% male, 95% White, mean 14.0±3.1 years of education, and 7.6±6.5 years post-transplant) were extracted for this study. The mean global cognition score was 24.5±3.0. More than half of LT recipients were classified as cognitively impaired; While 47 LT recipients (44%) scored within the MoCA’s normal range, 39 recipients (36%) scored within the mild CI range, 20 recipients (19%) scored within the moderate CI range, and one recipient (0.9%) scored within the range of dementia. Global CI was found more frequently in older LT recipients (age over 65 years). LT recipients who were older, male, married, less educated, or received deceased donor LT had lower domain-specific cognitive scores than those who were younger, female, single, had higher education, or received living donor LT. Cognition was not significantly different by time since LT.

*Conclusions: The findings of this study inform future directions to address post-transplant CI. This study found that LT recipients at any time point post-transplant experience cognitive impairment. It is necessary to prioritize examination of cognition for extended time points post-transplant. Future longitudinal studies should be conducted to develop profiles of LT recipients at higher risks of developing post-transplant CI.

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