Prospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 28, 2016; 8(30): 1279-1286
Published online Oct 28, 2016. doi: 10.4254/wjh.v8.i30.1279
Reversibility of minimal hepatic encephalopathy following liver transplantation in Egyptian cirrhotic patients
Mahmoud A Osman, Moataz M Sayed, Khaled A Mansour, Shereen A Saleh, Wesam A Ibrahim, Sara M Abdelhakam, Mohamed Bahaa, Wael A Yousry, Hosam S Elbaz, Reginia N Mikhail, Azza M Hassan, Ehab H Elsayed, Dalia A Mahmoud
Mahmoud A Osman, Moataz M Sayed, Khaled A Mansour, Shereen A Saleh, Wesam A Ibrahim, Wael A Yousry, Hosam S Elbaz, Reginia N Mikhail, Department of Internal Medicine, Hepatology and Gastroenterology, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt
Sara M Abdelhakam, Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt
Mohamed Bahaa, Department of Hepatobiliary Surgery, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt
Azza M Hassan, Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt
Ehab H Elsayed, Department of Internal Medicine, Hepatology and Gastroenterology, National Research Center, Cairo 11341, Egypt
Dalia A Mahmoud, Department of Neuropsychiatry, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt
Author contributions: Osman MA and Mahmoud DA contributed equally to this work; Osman MA, Sayed MM, Mansour KA, Saleh SA, Abdelhakam SM, Bahaa M and Mahmoud DA designed the research; Osman MA, Ibrahim WA, Bahaa M, Yousry WA, Elbaz HS, Mikhail RN and Mahmoud DA performed the research; Osman MA, Elbaz HS, Mikhail RN, Elsayed EH, Hassan AM and Mahmoud DA analyzed the data; Sayed MM, Mansour KA, Saleh SA, Ibrahim WA, Abdelhakam SM, Yousry WA and Hassan AM contributed analytic tools; Sayed MM, Saleh SA, Ibrahim WA, Abdelhakam SM and Yousry WA wrote the paper.
Institutional review board statement: This study was reviewed and approved by the Research Ethics Committee of Faculty of Medicine, Ain Shams University Institutional Review Board.
Clinical trial registration statement: This study is registered at (https://clinicaltrials.gov/show/NCT02767622). The registration identification number is (NCT02767622 Unique Protocol ID: 875).
Informed consent statement: All study participants provided written informed consent prior to study enrollment.
Conflict-of-interest statement: None of the authors have any conflicts of interests or any financial disclosures.
Data sharing statement: The technical appendix, statistical code and dataset are available from the corresponding author at saratropical@yahoo.com. The participants gave informed consent for the data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sara M Abdelhakam, MD, Assistant Professor of Tropical Medicine, Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Khalifa El-Maamon St., Abbassia, Cairo 11341, Egypt. saratropical@yahoo.com
Telephone: +20-100-1601548 Fax: +20-22-2598751
Received: May 28, 2016
Peer-review started: May 30, 2016
First decision: July 20, 2016
Revised: August 6, 2016
Accepted: September 13, 2016
Article in press: September 18, 2016
Published online: October 28, 2016
Processing time: 80 Days and 3.3 Hours
Abstract
AIM

To evaluate the reversibility of minimal hepatic encephalopathy (MHE) following liver transplantation (LT) in Egyptian cirrhotic patients.

METHODS

This prospective study included twenty patients with biopsy-proven liver cirrhosis listed for LT and twenty age- and sex-matched healthy control subjects. All underwent neuro-psychiatric examination, laboratory investigations, radiological studies and psychometric tests including trail making test A (TMT A), TMT B, digit symbol test and serial dotting test. The psychometric hepatic encephalopathy score (PHES) was calculated for patients to diagnose MHE. Psychometric tests were repeated six months following LT in the cirrhotic patient group.

RESULTS

Before LT, psychometric tests showed highly significant deficits in cirrhotic patients in comparison to controls (P < 0.001). There was a statistically significant improvement in test values in the patient group after LT; however, their values were still significantly worse than those of the controls (P < 0.001). The PHES detected MHE in 16 patients (80%) before LT with a median value of -7 ± 3.5. The median PHES value was significantly improved following LT, reaching -4.5 ± 5 (P < 0.001), and the number of patients with MHE decreased to 11 (55%). The pre-transplant model for end-stage liver disease (MELD) score ≥ 15 was significantly related to the presence of post-transplant MHE (P = 0.005). More patients in whom reversal of MHE was observed had a pre-transplant MELD score < 15.

CONCLUSION

Reversal of MHE in cirrhotic patients could be achieved by LT, especially in those with a MELD score < 15.

Keywords: Liver transplantation; Model for end-stage liver disease score; Psychometric tests; Minimal hepatic encephalopathy; Cirrhosis

Core tip: We evaluated the reversibility of minimal hepatic encephalopathy (MHE) following liver transplantation (LT) in Egyptian cirrhotic patients. Twenty patients with biopsy-proven liver cirrhosis listed for LT and twenty age- and sex-matched healthy controls were included. All underwent psychometric tests including trail making test A, trail making test B, digit symbol test and serial dotting test. Psychometric hepatic encephalopathy score was calculated for patients to diagnose MHE. Psychometric tests were repeated six months following LT in the cirrhotic patient group. We found that the reversal of MHE could be achieved by LT especially in those with a model for end-stage liver disease score < 15.