COGNITIVE impairment remains a significant concern for liver transplant recipients, with new research showing that neurological decline persists even when hepatic encephalopathy is no longer present. A study assessing patients six months after liver transplantation found that 60% met diagnostic criteria for neurocognitive disorder, with no single cause identified for this ongoing decline.
Researchers evaluated 20 liver transplant recipients, with a mean age of 61 years and a majority male cohort. Initial cognitive screening using tablet-based tools revealed markedly lower scores in those with neurocognitive disorder, particularly in executive function, compared with their cognitively intact counterparts.
Blood biomarker analysis showed decreases across most measures following transplantation. However, levels of phosphorylated tau protein (p-tau217) increased in those with neurocognitive disorder, suggesting possible ongoing neurodegenerative processes. Brain MRI with voxel-based morphometry revealed areas of increased atrophy in affected patients, but without a clear pattern of lobar involvement.
The study also examined potential contributing factors, identifying multiple possible influences on cognitive status. These included pre-existing brain changes and other systemic factors, but none emerged as a single definitive cause. This suggests that post-transplant cognitive impairment may result from a complex interplay of pre- and post-surgical influences rather than a single underlying pathology.
The findings highlight the need for ongoing cognitive monitoring in liver transplant recipients and point to a critical gap in understanding the mechanisms behind post-transplant cognitive decline. The authors emphasize that larger, longitudinal studies will be necessary to clarify causative factors and inform targeted prevention and treatment strategies.
Reference:
Berry K et al. Cognitive impairment in liver transplant recipients: comprehensive post-transplant neurologic and cognitive characterization. Neurology. 2025;1(3).
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