The importance of hepatic encephalopathy: Pre-transplant and post-transplant

✍ Scribed by Andrea DiMartini; Kapil Chopra

• Publisher: John Wiley and Sons
• Year: 2009
• Tongue: English
• Weight: 65 KB
• Volume: 15
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.21638

✦ Synopsis

This issue of Liver Transplantation features an interesting article by Sotil et al. 1 that further substantiates the clinical significance of hepatic encephalopathy (HE) and its potential effect on patient functioning in the years following liver transplantation (LTX). With the implementation of the Model for End-Stage Liver Disease (MELD) system of organ allocation, HE was not included in the MELD score for prioritizing patients for LTX because it was not found to influence short-term survival. 2 However, Sotil et al. suggest that beyond the prediction of survival, pre-LTX HE has important implications for persisting neurological deficits post-LTX. Their point is well taken. Transplant outcomes have largely moved beyond mere survival to improving patient quantity and quality of life. In this context, the importance of HE cannot be overemphasized. Diagnosing HE is essential to improving treatment and prognosticating about the potential for recovery following LTX. Clinicians, patients, and families alike need to be aware of the signs and symptoms of HE in order to prepare for LTX and the post-LTX recovery. Although the current study by Sotil et al. highlights the critical issue of the persistence of post-LTX cognitive impairment, it additionally raises the yet unanswered question of whether early identification and treatment could prevent or at least minimize these persisting effects. Several key points on HE deserve further discussion.