Postoperative cognitive dysfunction after liver transplantation

Abstract

Objective: Postoperative cognitive dysfunction (POCD) in liver transplant (LT) recipients is defined as a "more than expected" postoperative deterioration in cognitive domains, including short-term and long-term memory, mood, consciousness and circadian rhythm. It is diagnosed, after exclusion of other neurological complications, by using specific neuropsychological tests that need preoperative baseline. The aim of this systematic review was to assess the prevalence of POCD after LT and to analyze patients' symptoms, type and timing of assessment used.

Methods: PubMed, MEDLINE and The Cochrane Li-brary were searched up from January 1986 to August 2014. Study eligibility criteria are as follows: prospective and retrospective studies on human adult subjects describing prevalence of POCD and/or its sequelae after LT episodes were included.

Results: Eighteen studies were identified. The timing of testing for POCD may vary between different studies and within the single study, ranging from 0.5 to 32 weeks. POCD occurs in up to 50% of LT recipient.

Conclusion: Future studies should be focused on detecting preoperative and intraoperative factors associated to POCD in order to carry out appropriate strategies aimed at reducing this disabling health condition. Relationship between POCD and long-term outcome needs to be investigated.

Keywords: Cerebral oxygenation; Minimal hepatic encephalopathy; Neurocognitive deficits; Neuroinflammation.