Cognitive Dysfunction in Liver Disease and Its Implications for Transplant Candidates

摘要

Purpose of ReviewIrreversible cognitive impairment is a contraindication to liver transplantation, but growing evidence suggests many etiologies of liver disease have cognitive manifestations independent of hepatic encephalopathy and with variable reversibilities.Recent FindingsWhile cognitive sequelae of chronic alcohol use have long been recognized, cognitive dysfunction associated with other liver disease etiologies such as chronic hepatitis C infection, non-alcoholic fatty liver disease, and primary biliary cirrhosis has been recognized. While mechanisms vary and are incompletely understood, inflammation appears to play a central role in causing cognitive dysfunction associated with these diseases.Further research is needed to determine optimal cognitive assessment tools for patients with liver disease, identify patients at greatest risk for cognitive impairment, determine which elements of cognitive impairment are reversible, and identify effective therapies. This information will inform neurologic evaluation at time of liver transplant evaluation as well as expectations for neurologic recovery post-transplant.