Reversibility of minimal hepatic encephalopathy following liver transplantation in Egyptian cirrhotic patients

Table 1 Laboratory data, Child-Pugh and model for end-stage liver disease scores before and after liver transplantation in the patients’ group

Variable	Before LT (median ± IQR)	After LT (median ± IQR)	Z	P value
INR	1.5 ± 0.6	1.4 ± 0.4	2.198	0.0291
ALT (N: 7-40 IU/L)	24.5 ± 35.25	19.5 ± 29.8	2.201	0.0261
AST (N: 7-37 IU/L)	44.5 ± 28	22.5 ± 13.75	2.918	0.0022
Total bilirubin (N: 0.2-1.2 mg/dL)	2 ± 2.45	1.4 ± 0.8	2.156	0.0291
Albumin (N: 3.5-5.3 g/dL)	2.3 ± 1.15	3.3 ± 0.9	3.021	0.0211
Creatinine (N: 0.5-1.2 mg/dL)	0.9 ± 0.4	1 ± 0.2	0.176	0.893
BUN (N: 20-40 mg/dL)	12 ± 6.8	11.5 ± 4.8	0.218	0.839
Sodium (N: 135-147 mEq/L)	132.5 ± 11.75	134.5 ± 10.8	0.197	0.856
Potassium (N: 3.5-5.3 mEq/L)	3.8 ± 0.7	4.4 ± 0.8	2.469	0.0111
Calcium (N: 9-11 mg/dL)	8.6 ± 1.1	8.9 ± 1.3	2.584	0.0072
Phosphorus (N: 3-4.5 mg/dL)	3.2 ± 0.6	3.6 ± 1.3	3.219	< 0.0012
Magnesium (N: 1.8-3.6 mg/dL)	2.1 ± 0.6	2.2 ± 0.7	1.777	0.076
Child-Pugh score	9 ± 4.5	6 ± 1.8	3.549	< 0.0012
MELD score	14.5 ± 6.5	11.5 ± 4.5	2.928	0.0022

¹Significant;

²Highly significant. Z: Wilcoxon signed ranks test; IQR: Inter-quartile range; INR: International normalized ratio; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BUN: Blood urea nitrogen; MELD: Model for end-stage liver disease; LT: Liver transplantation; N: Normal range.

Table 2 Median score values of different psychometric tests in controls and patients before and after liver transplantation

	Controls	Patients before LT	Patients after LT	Patients before LT vs after LT (P value)1	Controls vs patients before LT (P value)2	Controls vs patients after LT (P value)2
TMT A (median ± IQR)	27 ± 8	110 ± 32.5	80 ± 30.8	0.010	< 0.001	< 0.001
TMT B (median ± IQR)	62 ± 17.3	282.5 ± 137.5	167.5 ± 72.0	0.002	< 0.001	< 0.001
DST (median ± IQR)	60 ± 4.75	22 ± 6	28.5 ± 14.5	0.001	< 0.001	< 0.001
SDT (median ± IQR)	34 ± 3.75	62 ± 20.75	51 ± 27.5	0.002	< 0.001	< 0.001
VMCP (median ± IQR)	1 ± 1	-7 ± 3.5	-4.5 ± 5.0	< 0.001	< 0.001	< 0.001

¹Wilcoxon signed ranks test;

²Mann Whitney U test. TMT: Trail making test; DST: Digit symbol test; SDT: Serial dotting test; VMCP: Visual-motor and visual-constructive performance score; LT: Liver transplantation; IQR: Inter-quartile range.

Table 3 Relation between pre-transplant model for end-stage liver disease score and the presence of pre- and post-transplant minimal hepatic encephalopathy n (%)

		Pre-transplant MELD score		χ2	P value
		< 15 (n = 10)	≥ 15 (n = 10)
Pre-transplant MHE	-ve	4 (40)	0 (0)	5.0001	0.087
	+ve	6 (60)	10 (100)
Post-transplant MHE	-ve	8 (80)	1 (10)	9.8991	0.0052
	+ve	2 (20)	9 (90)

¹Fisher’s exact test;

²Highly significant. MELD: Model for end-stage liver disease; MHE: Minimal hepatic encephalopathy; -ve: Negative; +ve: Positive.

Table 4 Comparison between recovered and non-recovered patients regarding age, sex, pre-transplant laboratory investigations and pre-transplant Child and model for end-stage liver disease scores

Variable	Recovered (n = 5) (median ± IQR)	Non-recovered (n = 11) (median ± IQR)	Z1	P value
INR	1.5 ± 0.5	1.7 ± 0.5	2.231	0.027
ALT	25 ± 51	38 ± 36	0.397	0.743
AST	49 ± 45.5	53 ± 39	0.283	0.827
Total bilirubin	1.4 ± 1	3.1 ± 2.9	2.437	0.013
Albumin	2.3 ± 1	2.3 ± 0.5	1.208	0.267
Creatinine	0.7 ± 0.5	0.9 ± 0.4	0.517	0.661
BUN	11 ± 11.5	12 ± 5	0.514	0.636
Sodium	139 ± 12.5	132 ± 7	0.910	0.377
Potassium	4 ± 1.2	3.6 ± 0.8	1.310	0.221
Calcium	8.9 ± 0.7	8.3 ± 1.3	0.746	0.482
Phosphorus	2.7 ± 0.8	3.2 ± 1.3	1.204	0.259
Magnesium	2.3 ± 0.6	2 ± 0.6	0.969	0.355
Child-Pugh score	9 ± 1.5	11 ± 1	2.140	0.038
MELD score	13 ± 3.5	17 ± 5	2.557	0.009
Age (mean ± SD)	56.6 ± 1.7	51.2 ± 6.1	1.9112	0.077
Sex
Male (n, %)	4 (80)	9 (81.8)	0.0073	1.000
Female (n, %)	1 (20)	2 (18.2)

¹Mann Whitney U test;

²Independent samples t-test;

³χ², Fisher’s exact test. INR: International normalized ratio; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BUN: Blood urea nitrogen; MELD: Model for end-stage liver disease; IQR: Inter-quartile range; SD: Standard deviation.