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مقاله شماره ۲۳
#Internal_Medicine
#Transplantation
عنوان:
Hepatic Encephalopathy Is Reversible in the Long Term After Liver Transplantation
نوع مطالعه:
Case - Control study
مجله:
Liver Transplantation
تاریخ انتشار:
22 August 2019
چکیده:
Cognitive dysfunction caused by hepatic encephalopathy (HE) improves within the first year after liver transplantation (LT). However, cognitive restitution seems to be incomplete in a subset of patients and after LT a new-onset cognitive decline was described. Data about the longterm development of cognitive function after liver transplantation (LT) are sparse. This prospective study analyzed whether a history of hepatic encephalopathy (HE) before LT had an impact on the longterm outcome of cognitive function after LT and if patients who underwent LT 5 years earlier showed worse cognitive function than healthy controls. The cognitive function of 34 patients was assessed before LT and at 1 year and 5 years after LT by psychometric tests, including the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the portosystemic encephalopathy syndrome test, which provides the psychometric hepatic encephalopathy score (PHES). Furthermore, patients completed surveys to assess health-related quality of life (HRQOL). An 22 additional patients were included after LT. Patients were subdivided by having a history of HE before LT. The control group consisted of 55 healthy patients adjusted for age and education. Before LT, patients performed significantly worse than controls in the psychometric tests: RBANS Total Scale (TS), mean ± standard deviation (SD), 92.6 ± 13.3 versus 99.9 ± 12.0, P = 0.01; and PHES, median (interquartile range [IQR]), 0 (-3 to 1) versus 1 (0-2), P < 0.001. At 1 year after LT, patients with a history of HE still showed cognitive impairment compared with controls: RBANS TS, mean ± SD, 89.8 ± 15.1 versus 99.9 ± 12.0, P < 0.01; and PHES, median (IQR), 0 (-2 to 1.25) versus 1 (0-2), P = 0.03. At 5 years after LT, patients with and without a history of HE showed normal cognitive function and improved HRQOL. In conclusion, HE-associated cognitive impairment seems to be reversible within 5 years after LT.
DOI: https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/lt.25626
توضیحات مهم:
✅ در این مطالعه آینده نگر ، وضعیت شناختی بیماران تحت پیوند ارزیابی شده است.
✔️ بیماران با و بدون سابقه انسفالوپاتی کبدی با کنترل های وابسته به سن با استفاده از ارزیابی های مختلف شناختی مقایسه شدند.
✔️ همانطور که انتظار می رفت ، بیماران قبل از پیوند کبد نسبت به کنترل ها در ارزیابی های شناختی بدتر بودند.
✔️ به طور جالب توجه ، با گذشت 5 سال از پیوند ، کاهش شناخت معکوس شده بود و با کنترل های مربوط به سن قابل مقایسه بود.
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