Decreased white matter lesion volume and improved cognitive function after liver transplantation

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Liver Failure/Cirrhosis/Portal Hypertension

Decreased white matter lesion volume and improved cognitive function after liver transplantation

Rovira 1 *, Beatriz Mínguez 2 3 4, F. Xavier Aymerich 1 6, Jacas 3 4 5, Elena Huerga 1, Córdoba 2 3 4, Juli Alonso 1 4

1Unitat de Ressonància Magnètica (I.D.I), Departament de Radiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain2Servei de Medicina Interna-Hepatologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain3Departament de Medicina. Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain4Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain5Unitat de Neuropsicología, Hospital Universitari Vall d'Hebron, Barcelona, Spain6Departament d'Enginyeria de Sistemes, Automàtica i Informàtica Industrial (ESAII), Universitat Politècnica de Catalunya, Barcelona, Spain

email: Rovira (alex.rovira@...)

*Correspondence to Rovira, Unitat de Ressonància Magnètica, Servei de Radiologia, Hospital General Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, Barcelona 08035, SpainPotential conflict of interest: Nothing to report.fax: )34( 934286059

Funded by: Instituto de Salud III FIS; Grant Number: PI030072, PI050226 FIS; Grant Number: CM04/00044

Abstract

Focal T2-weighted white matter lesions (WML) on brain magnetic resonance imaging (MRI), mimicking those seen in cerebrovascular small-vessel disease described in patients with persistent hepatic encephalopathy, decreased in volume with the improvement of hepatic encephalopathy. This outcome has been interpreted as a decrease in the edema that it is proposed to be involved in the pathogenesis of hepatic encephalopathy. We designed a study to further investigate potential changes in focal WML in the brains of patients with cirrhosis following liver transplantation and to study the relationship between these changes and overall cognitive function. We used MRI to measure the volume of supratentorial focal WML and a neuropsychological examination to assess cognitive function before and after liver transplantation in 27 patients with cirrhosis without signs of overt hepatic encephalopathy. Baseline MRI identified focal T2-weighted lesions in 19 patients (70.3%). The presence of WML was associated with older age but not with vascular risk factors, severity of liver function, or psychometric tests. A significant reduction in lesion volume was observed after liver transplantation (from a median of 1.306 cm3 to 0.671 cm3, P = 0.001). This decrease correlated with an improvement in an index of global cognitive function (r = -0.663; P < 0.001). This evolution indicates that lesion volume is partially related to a reversible type of tissue damage, which is compatible with brain edema.

Conclusion: Focal WML probably induced by age-related microvascular injury can decrease their volume with liver transplantation. The associated improvement of cognitive function supports a relationship between brain edema and minimal hepatic encephalopathy. (HEPATOLOGY 2007.)

Received: 25 April 2007; Accepted: 3 July 2007

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