Department of Psychology, University of Bologna, Bologna, Italy.
Transplantation. 2012 Mar 27;93(6):639-43. doi: 10.1097/TP.0b013e318244f734.
The long-term effect of liver transplantation (LT) on cognitive functions and the complete reversibility of minimal hepatic encephalopathy are poorly documented. Much evidence indicates that spatial attention improves starting from the immediate period after LT. However, at least in the first 2 years, some cognitive defects seem to persist to some degree, especially for supramodal nonverbal cognitive functions. The aim of this study is to investigate (i) whether the improvements observed in the perioperative period fluctuate or remain stable 10 years after LT and (ii) whether the functions that have been found defective also improve.
We called patients previously included in a prospective study (Mattarozzi et al., Arch Neurol 2004; 61: 242) for a further neuropsychological evaluation. We compared the cognitive evaluation after 7 to 10 years with previous data gathered 6 and 18 months after LT.
The improvements obtained in the first 2 years after transplantation remain stable during the 7 to 10 years thereafter, especially for visuospatial attention, F(12,96) 1.70; P=0.04 and selective attention, F(6,66) 3.51; P=0.005. Furthermore, these findings also seem to suggest an improvement in supramodal cognitive functions, such as spatial planning intelligence, measured by the Elithorn Maze Test, F(3,33) 7.42; P=0.002. Verbal short-term memory, F(3,33) 3.69; P=0.038, and visuospatial short-term memory, F(6,64) 2.97; P=0.013, show a more fluctuating trend over time.
Despite the risk of surgery, the neurotoxicity of immunosuppression therapy, and the effects of aging and related comorbidities, our data indicate that LT is able to significantly improve patients' cognitive functions in the long term.
肝移植（LT）对认知功能的长期影响以及轻微肝性脑病的完全可逆性记录甚少。大量证据表明，空间注意力从 LT 后即刻开始改善。然而，至少在前 2 年内，一些认知缺陷似乎在某种程度上仍然存在，尤其是对于超模式的非语言认知功能。本研究旨在调查：（i）术后期间观察到的改善是否在 LT 后 10 年波动或保持稳定，以及（ii）发现的功能缺陷是否也得到改善。
我们召集了之前参与一项前瞻性研究（Mattarozzi 等人，Arch Neurol 2004；61：242）的患者进行进一步的神经心理学评估。我们将术后 7 至 10 年的认知评估与 LT 后 6 和 18 个月收集的先前数据进行比较。
移植后 2 年内获得的改善在随后的 7 至 10 年内保持稳定，特别是在视空间注意力方面，F（12，96）1.70；P=0.04 和选择性注意力，F（6，66）3.51；P=0.005。此外，这些发现似乎还表明超模式认知功能得到了改善，例如空间规划智能，通过 Elithorn 迷宫测试测量，F（3，33）7.42；P=0.002。言语短期记忆，F（3，33）3.69；P=0.038，以及视空间短期记忆，F（6，64）2.97；P=0.013，随着时间的推移呈现出更波动的趋势。
尽管存在手术风险、免疫抑制治疗的神经毒性以及衰老和相关合并症的影响，但我们的数据表明，LT 能够长期显著改善患者的认知功能。
