Prospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Apr 8, 2017; 9(10): 519-532
Published online Apr 8, 2017. doi: 10.4254/wjh.v9.i10.519
Hepatic encephalopathy before and neurological complications after liver transplantation have no impact on the employment status 1 year after transplantation
Henning Pflugrad, Anita B Tryc, Annemarie Goldbecker, Christian P Strassburg, Hannelore Barg-Hock, Jürgen Klempnauer, Karin Weissenborn
Henning Pflugrad, Anita B Tryc, Annemarie Goldbecker, Karin Weissenborn, Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
Henning Pflugrad, Anita B Tryc, Annemarie Goldbecker, Karin Weissenborn, Integrated Research and Treatment Centre Transplantation, 30625 Hannover, Germany
Christian P Strassburg, Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, 30625 Hannover, Germany
Christian P Strassburg, Department of Medicine I, University Hospital Bonn, 53127 Bonn, Germany
Hannelore Barg-Hock, Jürgen Klempnauer, Clinic for Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany
Author contributions: Pflugrad H drafted the manuscript, collected data, analysed and interpreted data and performed the statistical analysis; Tryc AB collected data, analysed and interpreted data and revised the manuscript; Goldbecker A collected data and revised the manuscript; Strassburg CP collected data and revised the manuscript; Barg-Hock H collected data and revised the manuscript; Klempnauer J collected data and revised the manuscript; Weissenborn K designed the study, collected data, analysed and interpreted data, drafted the manuscript, performed the statistical analysis and supervised the study; all authors read and approved the final manuscript.
Supported by The German Federal Ministry of Education and Research, No. 01EO0802.
Institutional review board statement: The study was reviewed and approved by the Hannover Medical School Institutional Review Board.
Clinical trial registration statement: This study was not registered as a clinical trial because it is an observational study and no interventions were performed to evaluate the effects on health outcomes. The registration policy applies only to prospective, randomized, controlled trials.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: There is no additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Henning Pflugrad, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. pflugrad.henning@mh-hannover.de
Telephone: +49-511-5323121 Fax: +49-511-5323123
Received: October 19, 2016
Peer-review started: October 21, 2016
First decision: January 5, 2017
Revised: January 23, 2017
Accepted: March 12, 2017
Article in press: March 13, 2017
Published online: April 8, 2017
Abstract
AIM

To investigate the impact of hepatic encephalopathy before orthotopic liver transplantation (OLT) and neurological complications after OLT on employment after OLT.

METHODS

One hundred and fourteen patients with chronic liver disease aged 18-60 years underwent neurological examination to identify neurological complications, neuropsychological tests comprising the PSE-Syndrome-Test yielding the psychometric hepatic encephalopathy score, the critical flicker frequency and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), completed a questionnaire concerning their occupation and filled in the short form 36 (SF-36) to assess health-related quality of life before OLT and 12 mo after OLT, if possible. Sixty-eight (59.6%) patients were recruited before OLT, while on the waiting list for OLT at Hannover Medical School [age: 48.7 ± 10.2 years, 45 (66.2%) male], and 46 (40.4%) patients were included directly after OLT.

RESULTS

Before OLT 43.0% of the patients were employed. The patients not employed before OLT were more often non-academics (employed: Academic/non-academic 16 (34.0%)/31 vs not employed 10 (17.6%)/52, P = 0.04), had more frequently a history of hepatic encephalopathy (HE) (yes/no; employed 15 (30.6%)/34 vs not employed 32 (49.2%)/33, P = 0.05) and achieved worse results in psychometric tests (RBANS sum score mean ± SD employed 472.1 ± 44.5 vs not employed 443.1 ± 56.7, P = 0.04) than those employed. Ten patients (18.2%), who were not employed before OLT, resumed work afterwards. The patients employed after OLT were younger [age median (range, min-max) employed 47 (42, 18-60) vs not employed 50 (31, 29-60), P = 0.01], achieved better results in the psychometric tests (RBANS sum score mean ± SD employed 490.7 ± 48.2 vs not employed 461.0 ± 54.5, P = 0.02) and had a higher health-related quality of life (SF 36 sum score mean ± SD employed 627.0 ± 138.1 vs not employed 433.7 ± 160.8; P < 0.001) compared to patients not employed after OLT. Employment before OLT (P < 0.001), age (P < 0.01) and SF-36 sum score 12 mo after OLT (P < 0.01) but not HE before OLT or neurological complications after OLT were independent predictors of the employment status after OLT.

CONCLUSION

HE before and neurological complications after OLT have no impact on the employment status 12 mo after OLT. Instead younger age and employment before OLT predict employment one year after OLT.

Keywords: Hepatic encephalopathy, Employment, Neurological complications, Cognitive function, Health-related quality of life, Liver transplantation

Core tip: This prospective study is the first to consider hepatic encephalopathy prior to liver transplantation, neurological complications after liver transplantation as well as socio-economic factors as risk factors for unemployment 1 year after transplantation. Our data confirm that employment status before liver transplantation is most important in predicting the employment status 12 mo after transplantation. However, neither prior-liver transplantation hepatic encephalopathy nor neurological complications after liver transplantation are independent risk factors for unemployment 1 year after transplantation.