Decreased white matter lesion volume and improved cognitive function after liver transplantation

• Published in: Hepatology (Baltimore, Md.) Vol. 46; no. 5; pp. 1485 - 1490
• Main Authors: Rovira, Alex, Mínguez, Beatriz, Aymerich, F. Xavier, Jacas, Carlos, Huerga, Elena, Córdoba, Juan, Alonso, Juli
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.11.2007; Wiley
• Subjects: Adult; Aged; Biological and medical sciences; Brain - pathology; Cognition; Female; Gastroenterology. Liver. Pancreas. Abdomen; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Hepatic Encephalopathy - etiology; Hepatic Encephalopathy - pathology; Hepatic Encephalopathy - psychology; Humans; Liver Cirrhosis - complications; Liver Cirrhosis - surgery; Liver Transplantation; Liver, biliary tract, pancreas, portal circulation, spleen; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Neuropsychological Tests; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; Human; Brain; Nervous system diseases; Pathogenesis; Liver; Hepatic disease; Nuclear magnetic resonance imaging; White matter; Cerebral disorder; Encephalon; Cirrhosis; Microcirculation; Encephalopathy; Blood vessel; Central nervous system disease; Gastroenterology; Medical imagery; Digestive diseases; Lesion; Cerebral edema; Cerebrovascular disease; Liver transplantation
• ISSN: 0270-9139; 1527-3350
• DOI: 10.1002/hep.21911

Focal T2‐weighted white matter lesions (WML) on brain magnetic resonance imaging (MRI), mimicking those seen in cerebrovascular small‐vessel disease described in patients with persistent hepatic encephalopathy, decreased in volume with the improvement of hepatic encephalopathy. This outcome has been interpreted as a decrease in the edema that it is proposed to be involved in the pathogenesis of hepatic encephalopathy. We designed a study to further investigate potential changes in focal WML in the brains of patients with cirrhosis following liver transplantation and to study the relationship between these changes and overall cognitive function. We used MRI to measure the volume of supratentorial focal WML and a neuropsychological examination to assess cognitive function before and after liver transplantation in 27 patients with cirrhosis without signs of overt hepatic encephalopathy. Baseline MRI identified focal T2‐weighted lesions in 19 patients (70.3%). The presence of WML was associated with older age but not with vascular risk factors, severity of liver function, or psychometric tests. A significant reduction in lesion volume was observed after liver transplantation (from a median of 1.306 cm3 to 0.671 cm3, P = 0.001). This decrease correlated with an improvement in an index of global cognitive function (r = −0.663; P < 0.001). This evolution indicates that lesion volume is partially related to a reversible type of tissue damage, which is compatible with brain edema. Conclusion: Focal WML probably induced by age‐related microvascular injury can decrease their volume with liver transplantation. The associated improvement of cognitive function supports a relationship between brain edema and minimal hepatic encephalopathy. (HEPATOLOGY 2007.)