Kornerup Linda Skibsted, Pflugrad Henning, Weissenborn Karin, Vilstrup Hendrik, Dam Gitte
Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus N, Denmark.
Department of Neurology, Hannover Medical School, Hannover, Germany.
Hepat Med. 2019 Mar 18;11:41-46. doi: 10.2147/HMER.S144667. eCollection 2019.
Liver transplantation (LT) represents the definitive treatment for end-stage liver disease. Cognitive impairment following LT is frequent, referred to as postliver transplant encephalopathy (PLTE). LT removes the underlying chronic liver disease, and until recently hepatic encephalopathy (HE) was assumed to be fully reversible after LT. However, increasing evidence indicates that some degree of cognitive impairment may be present after LT. To which extent PLTE reflects cognitive impairment caused by residual HE (RHE) or the combined effect of other factors affecting brain function before, during, and after LT is not clarified. None of the available psychometric and neurophysiological tests used for detecting HE is shown to be able to distinguish between etiologies. The available, mostly retrospective, clinical studies indicate a high prevalence of abnormal psychometric tests after LT, and not all seem to recover completely. The patients with earlier HE show the most marked improvements, suggesting that the clinical picture of the early PLTE, in fact, represents RHE. Other early post-LT etiologies for PLTE comprise cerebral ischemia, critical illness encephalopathy, and immunosuppressive therapy. Late-onset etiologies comprise diabetes and hypertension, among others. PLTE regardless of etiology is a worrying issue and needs more attention in the form of mechanistic research, development of diagnostic/discriminative tools, and standardized prospective clinical studies.
肝移植（LT）是终末期肝病的确定性治疗方法。肝移植后认知障碍很常见，称为肝移植后脑病（PLTE）。肝移植消除了潜在的慢性肝病，直到最近，肝性脑病（HE）在肝移植后仍被认为是完全可逆的。然而，越来越多的证据表明，肝移植后可能存在一定程度的认知障碍。PLTE在多大程度上反映了残留肝性脑病（RHE）引起的认知障碍，或者是肝移植前、肝移植期间和肝移植后影响脑功能的其他因素的综合作用，目前尚不清楚。用于检测肝性脑病的现有心理测量和神经生理学测试均未显示能够区分病因。现有的临床研究大多为回顾性研究，表明肝移植后心理测量测试异常的患病率很高，而且并非所有患者似乎都能完全康复。早期患有肝性脑病的患者改善最为明显，这表明早期PLTE的临床表现实际上代表了残留肝性脑病。肝移植后早期PLTE的其他病因包括脑缺血、危重病性脑病和免疫抑制治疗。晚期病因包括糖尿病和高血压等。无论病因如何，PLTE都是一个令人担忧的问题，需要通过机制研究、诊断/鉴别工具的开发以及标准化的前瞻性临床研究等形式给予更多关注。
