Hepatic encephalopathy before and neurological complications after liver transplantation have no impact on the employment status 1 year after transplantation

Table 1 Self-reporting questionnaire occupation n (%)

n = 114	Before OLT	After OLT
Employed	36 (31.6)	33 (34.4)1
Retired	48 (42.1)	49 (51.0)1
Unemployed	7 (6.1)	2 (2.1)1
Certified unfit for work	10 (8.8)	2 (2.1)1
Homemaker	8 (7.0)	6 (6.3)1
Student	5 (4.4)	4 (4.2)1
Deceased	-	18 (15.8)

¹Percent value is based on n = 96 survivors. OLT: Orthotopic liver transplantation.

Table 2 Characteristics of employed and not employed patients before orthotopic liver transplantation

n = 114	Employed (n = 49)	Not employed (n = 65)	P value
Age median (range, min-max)	49 (42,18-60)	50 (36, 24-60)	0.06
Sex (male/female)	30 (61.2%)/19	42 (64.6%)/26	0.85
Profession Academic/non-academic	16 (34.0%)/31 (NS 2)	10 (17.6%)/52 (NS 3)	0.04
labMELD median (range, min-max)	18 (33, 7-40)	18 (33, 7-40)	0.16
Aetiology of liver disease			0.44
PSC	16	14
PBC	0	1
Alcohol	5	10
HCV	7	11
HBV	5	13
AIH	3	1
M. Wilson	3	1
Others	10	14
History of HE (+/-)	15 (30.6%)/34	32 (49.2%)/33	0.05
PHES, median (min/max)	0 (-8/+5) (n = 27)	-2 (-18/+4) (n = 37)	0.04
CFF, mean ± SD	42.7 ± 3.9 (n = 26)	42.3 ± 5.0 (n = 35)	0.77
RBANS Immediate memory, mean ± SD	92.2 ± 17.0 (n = 24)	89.6 ± 18.6 (n = 32)	0.59
RBANS Visuospatial/constructional, median (range, min-max)	84 (60, 66-126) (n = 24)	84 (66, 60-126) (n = 32)	0.26
RBANS Language, mean ± SD	99.3 ± 11.6 (n = 24)	96.2 ± 14.4 (n = 32)	0.40
RBANS Attention, mean ± SD	91.8 ± 17.3 (n = 24)	84.2 ± 16.6 (n = 32)	0.10
RBANS Delayed memory, median (range, min-max)	97 (36, 86-122) (n = 24)	94.5 (64, 44-108) (n = 32)	0.24
RBANS Sum score, mean ± SD	472.1 ± 44.5 (n = 24)	443.1 ± 56.7 (n = 32)	0.04
RBANS Total scale, mean ± SD	92.1 ± 11.6 (n = 24)	84.9 ± 14.4 (n = 32)	0.05

P value ≤ 0.05 is considered significant. NS: Not specified; OLT: Orthotopic liver transplantation; labMELD: Laboratory Model of End Stage Liver Disease; PSC: Primary sclerosing cholangitis; PBC: Primary biliary cirrhosis; HCV: Hepatitis C virus; HBV: Hepatitis B virus; AIH: Autoimmune hepatitis; HE: Hepatic encephalopathy; PHES: Psychometric hepatic encephalopathy score; CFF: Critical flicker frequency; RBANS: Repeatable Battery for the Assessment of Neuropsychological Status.

Table 3 Characteristics of employed and not employed patients after orthotopic liver transplantation

n = 96	Employed (n = 43)	Not employed (n = 53)	P value
Age median (range, min-max)	47 (42, 18-60)	50 (31, 29-60)	0.01
Sex (male/female)	23 (53.5%)/20	36 (67.9%)/17	0.21
Profession Academic/non-academic	13 (31.0%)/29 (NS 1)	8 (15.1%)/45	0.08
labMELD median (range, min-max)	18 (33, 7-40)	19 (33, 7-40)	0.16
Aetiology of liver disease			0.41
PSC	15	13
PBC	1	0
Alcohol	4	8
HCV	7	6
HBV	3	12
AIH	2	1
M. Wilson	2	1
Others	9	12
History of HE (+/-)	13 (30.2%)/30	25 (47.2%)/28	0.10
Neurological complications (+/-)	17 (39.5%)/26	30 (56.6%)/23	0.11
PHES, median (min/max)	0 (-5/+2) (n = 30)	-1 (-10/+4) (n = 43)	0.10
CFF, mean ± SD	45.8 ± 4.0 (n = 29)	42.0 ± 4.1 (n = 40)	< 0.001
RBANS Immediate memory, mean ± SD	101.1 ± 15.1 (n = 30)	92.1 ± 17.7 (n = 41)	0.03
RBANS Visuospatial/constructional, median (range, min-max)	84 (64, 62-126) (n = 30)	89 (57, 64-121) (n = 41)	0.17
RBANS Language, mean ± SD	103.2 ± 13.9 (n = 30)	93.0 ± 16.5 (n = 41)	0.01
RBANS Attention, mean ± SD	101.2 ± 13.7 (n = 30)	89.3 ± 15.5 (n = 41)	0.001
RBANS Delayed memory, median (range, min-max)	98 (109, 10-119) (n = 30)	95 (44, 75-119) (n = 41)	0.13
RBANS Sum score, mean ± SD	490.7 ± 48.2 (n = 30)	461.0 ± 54.5 (n = 41)	0.02
RBANS Total scale, mean ± SD	97.4 ± 13.6 (n = 30)	89.6 ± 14.2 (n = 41)	0.02

P value ≤ 0.05 is considered significant. NS: Not specified; OLT: Orthotopic liver transplantation; labMELD: Laboratory Model of End Stage Liver Disease; PSC: Primary sclerosing cholangitis; PBC: Primary biliary cirrhosis; HCV: Hepatitis C virus; HBV: Hepatitis B virus; AIH: Autoimmune hepatitis; HE: Hepatic encephalopathy; PHES: Psychometric hepatic encephalopathy score; CFF: Critical flicker frequency; RBANS: Repeatable Battery for the Assessment of Neuropsychological Status.

Table 4 Short form 36 domain scores and six-dimension health state short form score of employed and not employed patients

SF-36 domain score	Before OLT		P value	After OLT		P value
	Employed (n = 27)	Not employed (n = 35)		Employed (n = 30)	Not employed (n = 41)
PF, mean ± SD	70.7 ± 25.1	47.4 ± 27.4	0.001	82.3 ± 19.2	59.4 ± 28.2	< 0.001
PRF, median (range, min-max)	50 (100, 0-100)	25 (100, 0-100)	0.14	100 (100, 0-100)	25 (100, 0-100)	< 0.001
BP, median (range, min-max)	74 (100, 0-100)	51 (100, 0-100)	0.14	100 (69, 31-100)	74 (88, 12-100)	0.001
GHP, median (range, min-max)	40 (77, 10-87)	35 (82, 0-82)	0.71	69.5 (87, 10-97)	50 (87, 10-97)	0.01
VIT, median (range, min-max)	45 (80, 10-90)	40 (85, 0-85)	0.43	70 (75, 20-95)	45 (85, 5-90)	0.001
SRF, median (range, min-max)	87.5 (87.5, 12.5-100)	62.5 (87.5, 12.5-100)	0.52	100 (50, 50-100)	62.5 (87.5, 12.5-100)	< 0.001
ERF, median (range, min-max)	100 (100, 0-100)	100 (100, 0-100)	0.94	100 (100, 0-100)	33.3 (100, 0-100)	< 0.001
MH, median (range, min-max)	76 (60, 32-92)	64 (88, 8-96)	0.31	80 (56, 44-100)	68 (72, 28-100)	0.01
Sum score, mean ± SD	479.2 ± 193.9	419.7 ± 169.7	0.20	627.0 ± 138.1	433.7 ± 160.8	< 0.001
SF-6D QALYs, mean ± SD	0.71 ± 0.14	0.64 ± 0.15	0.06	0.8 ± 0.1	0.64 ± 0.12	< 0.001

P value ≤ 0.05 is considered significant. SF-36: Short form 36; SF-6D: Six-dimension health state short form; OLT: Orthotopic liver transplantation; PF: Physical functioning; PRF: Physical role functioning; BP: Bodily pain; GHP: General health perception; VIT: Vitality; SRF: Social role functioning; ERF: Emotional role functioning; MH: Mental health; QALYs: Quality adjusted life years.

Table 5 Comparison of patients employed before and after orthotopic liver transplantation to patients employed before but not-employed after orthotopic liver transplantation

n = 41	Employed before and after OLT (n = 33)	Employed before but not employed after OLT (n = 8)	P value
Age, median (range, min-max)	50 (42, 18-60)	54 (30, 29-59)	0.13
Sex (male/female)	18 (54.5%)/15	6 (75.0%)/2	0.43
Profession Academic/non-academic	11 (34.4%)/21 (NS 1)	3 (37.5%)/5	1.00
labMELD median (range, min-max)	18 (33, 7-40)	17 (31, 9-40)	0.91
Aetiology of liver disease			0.19
PSC	12	2
PBC	0	0
Alcohol	3	0
HCV	6	0
HBV	2	2
AIH	2	1
M. Wilson	2	0
Others	6	3
History of HE (+/-)	9 (27.3%)/24	2 (25.0%)/6	1.00
Neurological complications (+/-)	11 (33.3%)/22	5 (62.5%)/3	0.23
PHES after OLT, median (min/max)	1 (-4/+2) (n = 25)	0 (-7/+4) (n = 7)	0.93
CFF after OLT, mean ± SD	45.3 ± 3.7 (n = 24)	41.7 ± 5.0 (n = 7)	0.04
RBANS after OLT Immediate memory, mean ± SD	101.6 ± 14.1 (n = 26)	89.4 ± 10.0 (n = 7)	0.04
RBANS after OLT Visuospatial/constructional median (range, min-max)	84 (64, 62-126) (n = 26)	89 (57, 64-121) (n = 7)	0.68
RBANS after OLT Language, mean ± SD	103.2 ± 14.6 (n = 26)	95.1 ± 24.2 (n = 7)	0.27
RBANS after OLT Attention, mean ± SD	100.8 ± 14.1 (n = 26)	87.1 ± 18.6 (n = 7)	0.04
RBANS after OLT Delayed memory, median (range, min-max)	98 (109, 10-119) (n = 26)	95 (17, 88-105) (n = 7)	0.16
RBANS after OLT Sum score, mean ± SD	492.0 ± 47.8 (n = 26)	457.0 ± 56.8 (n = 7)	0.11
RBANS after OLT Total scale, mean ± SD	97.7 ± 13.7 (n = 26)	88.3 ± 14.6 (n = 7)	0.12

P value ≤ 0.05 is considered significant. NS: Not specified; OLT: Orthotopic liver transplantation; labMELD: Laboratory Model of End Stage Liver Disease; PSC: Primary sclerosing cholangitis; PBC: Primary biliary cirrhosis; HCV: Hepatitis C virus; HBV: Hepatitis B virus; AIH: Autoimmune hepatitis; HE: Hepatic encephalopathy; PHES: Psychometric hepatic encephalopathy score; CFF: Critical flicker frequency; RBANS: Repeatable Battery for the Assessment of Neuropsychological Status.

Table 6 Short form 36 domain scores and six-dimension health state short form score of patients employed before and after orthotopic liver transplantation compared to patients employed before but not-employed after orthotopic liver transplantation

SF-36 domain score	Before OLT		P value	After OLT		P value
	Employed before and after OLT (n = 17)	Employed before and not employed after OLT (n = 4)		Employed before and after OLT (n = 26)	Employed before and not employed after OLT (n = 7)
PF, mean ± SD	75.9 ± 23.8	55.0 ± 31.6	0.15	84.6 ± 17.0	45.0 ± 23.5	< 0.001
PRF, median (range, min-max)	50 (100, 0-100)	62.5 (50, 25-75)	0.97	100 (100, 0-100)	25 (50, 0-50)	0.001
BP, median (range, min-max)	84 (100, 0-100)	81 (48, 52-100)	0.90	100 (49, 51-100)	52 (78, 22-100)	0.03
GHP, median (range, min-max)	50 (72, 10-82)	35 (42, 25-67)	0.64	72 (77, 20-97)	60 (72, 15-87)	0.31
VIT, median (range, min-max)	45 (80, 10-90)	42.5 (60, 20-80)	0.97	70 (75, 20-95)	50 (70, 10-80)	0.04
SRF, median (range, min-max)	87.5 (87.5, 12.5-100)	87.5 (50, 50-100)	0.70	100 (37.5, 62.5-100)	50 (62.5, 37.5-100)	< 0.01
ERF, median (range, min-max)	100 (100, 0-100)	66.7 (100, 0-100)	0.70	100 (100, 0-100)	33.3 (100, 0-100)	0.05
MH, median (range, min-max)	72 (60, 32-92)	74 (24, 56-80)	0.83	82 (48, 52-100)	76 (56, 44-100)	0.22
Sum score, mean ± SD	512.1 ± 193.4	487.1 ± 172.2	0.82	652.9 ± 100.7	418.5 ± 121.5	< 0.001
SF-6D QALYs, mean ± SD	0.72 ± 0.14	0.72 ± 0.15	0.94	0.83 ± 0.1	0.65 ± 0.10	< 0.001

P value ≤ 0.05 is considered significant. SF-36: Short form 36; SF-6D: Six-dimension health state short form; OLT: Orthotopic liver transplantation; PF: Physical functioning; PRF: Physical role functioning; BP: Bodily pain; GHP: General health perception; VIT: Vitality; SRF: Social role functioning; ERF: Emotional role functioning; MH: Mental health; QALYs: Quality adjusted life years.

Table 7 Comparison of patients not employed before and after orthotopic liver transplantation to patients not employed before but employed after orthotopic liver transplantation

n = 55	Not Employed before and after OLT (n = 45)	Not employed before but employed after OLT (n = 10)	P value
Age, median (range, min-max)	50 (28, 32-60)	41 (34, 26-60)	0.03
Sex (male/female)	30 (66.7%)/15	5 (50%)/5	0.47
Profession Academic/non-academic	5 (11.1%)/40	2 (20%)/8	0.6
labMELD median (range, min-max)	19 (33, 7-40)	20 (24, 8-32)	0.74
Aetiology of liver disease			0.2
PSC	11	3
PBC	0	1
Alcohol	8	1
HCV	6	1
HBV	10	1
AIH	0	0
M. Wilson	1	0
Others	9	3
History of HE (+/-)	23 (51.1%)/22	4 (40%)/6	0.73
Neurological complications (+/-)	25 (55.6%)/20	6 (60%)/4	1.0
PHES after OLT, median (min/max)	-1 (-10/+4) (n = 36)	0 (-5/+2) (n = 5)	0.63
CFF after OLT, mean ± SD	42.0 ± 4.0 (n = 33)	47.9 ± 5.2 (n = 5)	< 0.01
RBANS after OLT Immediate memory, mean ± SD	92.7 ± 19.0 (n = 34)	97.8 ± 22.9 (n = 4)	0.62
RBANS after OLT Visuospatial/constructional, median (range, min-max)	90.5 (55, 66-121) (n = 34)	84 (11, 78-89) (n = 4)	0.32
RBANS after OLT Language, mean ± SD	92.5 ± 14.8 (n = 34)	103.5 ± 10.3 (n = 4)	0.16
RBANS after OLT Attention, mean ± SD	89.7 ± 15.1 (n = 34)	104.0 ± 12.6 (n = 4)	0.08
RBANS after OLT Delayed memory, median (range, min-max)	96 (44, 75-119) (n = 34)	98.5 (34, 71-105) (n = 4)	1.0
RBANS after OLT Sum score, mean ± SD	461.9 ± 54.8 (n = 34)	482.3 ± 57.6 (n = 4)	0.49
RBANS after OLT Total scale, mean ± SD	89.9 ± 14.3 (n = 34)	95.0 ± 14.5 (n = 4)	0.51

P value ≤ 0.05 is considered significant. OLT: Orthotopic liver transplantation; NS: Not specified; labMELD: Laboratory Model of End Stage Liver Disease; PSC: Primary sclerosing cholangitis; PBC: Primary biliary cirrhosis; HCV: Hepatitis C virus; HBV: Hepatitis B virus; AIH: Autoimmune hepatitis; HE: Hepatic encephalopathy; PHES: Psychometric hepatic encephalopathy score; CFF: Critical flicker frequency; RBANS: Repeatable Battery for the Assessment of Neuropsychological Status.

Table 8 Short form 36 domain scores and six-dimension health state short form score of patients not employed before and after orthotopic liver transplantation compared to patients not employed before but employed after orthotopic liver transplantation

SF-36 domain score	Before OLT		P value	After OLT		P value
	Not employed before and after OLT (n = 25)	Not employed before but employed after OLT (n = 6)		Not employed before and after OLT (n = 34)	Not employed before but employed after OLT (n = 4)
PF, mean ± SD	48.2 ± 26.8	57.5 ± 26.0	0.45	62.4 ± 28.5	67.5 ± 28.4	0.74
PRF, median (range, min-max)	25 (100, 0-100)	62.5 (100, 0-100)	0.45	25 (100, 0-100)	25 (100, 0-100)	1.0
BP, median (range, min-max)	51 (100, 0-100)	56.5 (78, 22-100)	0.79	74 (88, 12-100)	52.5 (69, 31-100)	0.70
GHP, median (range, min-max)	35 (67, 15-82)	43.5 (52, 0-52)	0.64	46 (87, 10-97)	41 (70, 10-80)	0.73
VIT, median (range, min-max)	40 (80, 5-85)	45 (65, 0-65)	0.79	45 (85, 5-90)	42.5 (35, 40-75)	0.70
SRF, median (range, min-max)	62.5 (87.5, 12.5-100)	81.3 (50, 50-100)	0.42	62.5 (87.5, 12.5-100)	68.8 (50, 50-100)	0.77
ERF, median (range, min-max)	100 (100, 0-100)	66.7 (67.7, 33.3-100)	0.21	33.3 (100, 0-100)	66.7 (66.7, 33.3-100)	0.48
MH, median (range, min-max)	68 (88, 8-96)	68 (80, 16-96)	0.79	68 (68, 28-96)	54 (56, 44-100)	0.57
Sum score, mean ± SD	419.4 ± 166.3	480.8 ± 180.4	0.43	436.9 ± 169.1	458.5 ± 237.3	0.82
SF-6D QALYs, mean ± SD	0.64 ± 0.15	0.71 ± 0.14	0.35	0.64 ± 0.12	0.65 ± 0.14	0.87

P value ≤ 0.05 is considered significant. SF-36: Short form 36; SF-6D: Six-dimension health state short form; OLT: Orthotopic liver transplantation; PF: Physical functioning; PRF: Physical role functioning; BP: Bodily pain; GHP: General health perception; VIT: Vitality; SRF: Social role functioning; ERF: Emotional role functioning; MH: Mental health; QALYs: Quality adjusted life years.

Table 9 Paired analysis of the short form 36 domain scores and the six-dimension health state short form score of patients employed after orthotopic liver transplantation surveyed before and 12 mo after orthotopic liver transplantation

SF-36 domain score, n = 16	Before OLT	After OLT	P value
PF, mean ± SD	71.6 ± 26.8	84.1 ± 18.6	0.04
PRF, mean ± SD	50.0 ± 47.4	82.8 ± 35.0	0.02
BP, mean ± SD	70.7 ± 34.5	88.8 ± 18.8	0.04
GHP, mean ± SD	46.9 ± 24.0	66.8 ± 24.0	0.01
VIT, mean ± SD	45.9 ± 23.8	68.4 ± 15.2	0.01
SRF, mean ± SD	70.3 ± 33.2	90.6 ± 15.5	0.06
ERF, mean ± SD	70.8 ± 43.7	91.7 ± 19.3	0.10
MH, mean ± SD	70.8 ± 18.7	80.0 ± 13.6	0.17
Sum score, mean ± SD	497.0 ± 191.7	653.2 ± 128.6	0.01
SF-6D QALYs, mean ± SD	0.71 ± 0.12	0.81 ± 0.10	0.02

P value ≤ 0.05 is considered significant, no correlation between first and second measurement. SF-36: Short form 36; SF-6D: Six-dimension health state short form; OLT: Orthotopic liver transplantation; PF: Physical functioning; PRF: Physical role functioning; BP: Bodily pain; GHP: General health perception; VIT: Vitality; SRF: Social role functioning; ERF: Emotional role functioning; MH: Mental health; QALYs: Quality adjusted life years.

Table 10 Paired analysis of the short form 36 domain scores and the six-dimension health state short form score of patients not employed after orthotopic liver transplantation surveyed before and 12 mo after orthotopic liver transplantation

SF-36 domain score, n = 21	Before OLT	After OLT	P value
PF, mean ± SD	48.1 ± 28.3	65.5 ± 29.0	0.03
PRF, mean ± SD	38.1 ± 40.0	41.6 ± 39.0	0.76
BP, mean ± SD	61.1 ± 31.3	70.0 ± 24.8	0.25
GHP, mean ± SD	41.8 ± 15.6	56.8 ± 22.2	0.01
VIT, mean ± SD	44.3 ± 20.0	51.2 ± 22.2	0.14
SRF, mean ± SD	65.5 ± 29.3	67.3 ± 21.1	0.80
ERF, mean ± SD	55.6 ± 45.1	57.1 ± 44.9	0.91
MH, mean ± SD	66.3 ± 16.3	69.1 ± 18.7	0.53
Sum score, mean ± SD	420.7 ± 163.8	478.6 ± 148.0	0.21
SF-6D QALYs, mean ± SD	0.64 ± 0.15	0.66 ± 0.10	0.46

P value ≤ 0.05 is considered significant, no correlation between first and second measurement. SF-36: Short form 36; SF-6D: Six-dimension health state short form; OLT: Orthotopic liver transplantation; PF: Physical functioning; PRF: Physical role functioning; BP: Bodily pain; GHP: General health perception; VIT: Vitality; SRF: Social role functioning; ERF: Emotional role functioning; MH: Mental health; QALYs: Quality adjusted life years.