Neuropsychological functioning in patients with alcohol-related liver disease before and after liver transplantation

Background. Cognitive dysfunction is common in both end-stage liver disease and chronic alcohol misuse. The impact of orthotopic liver transplantation (OLT) on neuropsychological function is poorly documented. This prospective study examined changes in cognitive function pre- and post-OLT in patients with alcohol-related liver disease (ALD). Methods. Comprehensive neuropsychological assessment was conducted with 92 abstinent patients with ALD scheduled for OLT. Forty-two patients were available for reassessment 12 months post-OLT. Results. Posttransplantation, cognitive performance on all measures fell within normal limits. Greatest improvement occurred in visuomotor speed, complex visual attention processes, and the ability to solve visually presented problems. Performance on memory assessment tasks also improved posttransplantation. Applying a more robust assessment of change (Reliable Change Index), approximately half improved reliably on overall cognitive function. One quarter improved in memory performance. With the exception of the Full-Scale Intelligence Quotient scales, discriminant analysis was unable to successfully predict which patients reliably improved. Conclusions. Overall improvement in cognitive function occurs after liver transplantation in ALD. It was not possible to identify which patient characteristics were associated with reliable change