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Functional Human Liver Preservation and Recovery by Means of Subnormothermic Machine Perfusion
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Liver transplantation significantly improves global functioning and cerebral processing.

Vishwadeep Ahluwalia1, James B Wade2, Melanie B White1

  • 1Divisions of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, Richmond, VA.

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
|June 25, 2016
PubMed
Summary
This summary is machine-generated.

Liver transplantation improves brain function and quality of life, but pretransplant cognitive impairment predicts poorer outcomes. Pretransplant cognitive status is key for managing post-transplant expectations.

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Area of Science:

  • Neuroscience
  • Transplant Surgery
  • Hepatology

Background:

  • Cognitive and quality of life (QoL) changes post-liver transplant (LT) lack clear functional basis.
  • Cirrhosis patients often exhibit cognitive impairment and hepatic encephalopathy (HE), impacting QoL.

Purpose of the Study:

  • Evaluate neurometabolic and functional brain changes post-LT.
  • Assess these changes as modulators of cognition and QoL.
  • Correlate pretransplant cognitive impairment and HE with post-LT outcomes.

Main Methods:

  • Cognitive and QoL assessments at baseline and 6 months post-LT.
  • Brain MRI including functional MRI (fMRI), diffusion tensor imaging (DTI), and magnetic resonance spectroscopy (MRS) pre- and post-LT.
  • Analysis of changes in relation to pretransplant cognitive impairment and HE status.

Main Results:

  • Post-LT, patients showed reduced brain activation for inhibitory control (fMRI), reversed ammonia-related metabolite changes (MRS), and improved white matter integrity (DTI).
  • QoL improved post-LT but less so in patients with pretransplant cognitive impairment.
  • Pretransplant cognitive impairment, not HE history, predicted post-LT cognitive and psychosocial outcomes.

Conclusions:

  • Functional brain changes after liver transplant are influenced by pretransplant cognitive impairment.
  • Pretransplant cognitive status is a critical predictor of post-LT neurobehavioral recovery and QoL.
  • Clinicians can use pretransplant cognitive profiles to set patient expectations for recovery.