Neurocognitive and Psychosocial Functioning of Liver Tranplant Candidates and Recipients

Cirrhosis is a severe and prevalent condition that is frequently treated using surgical liver transplantation. Individuals with liver disease often experience neurological complications as well as problems in general psychosocial functioning. In addition, it is possible that factors associated with the transplant procedure itself may affect cognitive functioning. To date, however, the cognitive dysfunctions associated with liver disease and transplantation have not been clearly identified. Such research is important because neuropsychological complications may be important contributors to the morbidity and mortality of patients with liver disease. The present study investigated the neuropsychological functioning of liver transplant candidates and recipients. Specifically, the following neuropsychological functions were examined: learning and memory, attention and concentration, executive functioning, motor skills, language, and visuo-spatial abilities. In addition, quality of life, psychological functioning, and coping strategies were also examined. This study compared 50 liver transplant candidates and 50 liver transplant recipients to one another and to a chronic disease control group comprised of heart and kidney transplant patients (50 candidates and 50 recipients). It was predicted that operative status, etiology, disease type, and immunosuppressive agent would significantly impact neuropsychological and psychosocial functioning. With the exception of immunosuppressive agent, overwhelming support for this prediction was found. Transplant recipients reported less depression and performed significantly better on neuropsychological tests of memory, attention, executive function, motor skills, language, and visuo-spatial abilities than transplant candidates. Etiology and disease type were also found to significantly affect memory, attention, executive function, motor skills, and language, with toxic and infectious liver subjects displaying impairments relative to heart, kidney, and non-toxic and non-infectious liver subjects. This study also hypothesized that preoperative neuropsychological and psychosocial functioning would predict the severity of liver disease and degree of encephalopathy. As predicted, neuropsychological functioning was predictive of both variables, and psychosocial function accounted for a significant amount of variance in encephalopathy