A Long-Term Study of Changes in the Volume of Brain Ventricles and White Matter Lesions After Successful Liver Transplantation
A Long-Term Study of Changes in the Volume of Brain Ventricles and White Matter Lesions After Successful Liver Transplantation
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DOI：
10.1097/tp.0b013e3181ca7bb3
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发表时间：
2010-03-15
期刊：
影响因子：
6.2
通讯作者：
Cordoba, Juan
中科院分区：
文献类型：
--
作者：
Garcia Martinez, Rita;Rovira, Alex;Cordoba, Juan
背景资料。肝移植受者由于更好的管理而延长了生存时间，使他们暴露在多种因素中，这些因素可能会长期损害神经功能。对22例患者在肝移植前即刻、术后6~12个月(短期)、术后6~9年(远期)进行脑磁共振检查，并进行神经心理评估。13名年龄匹配的健康对照组被平行研究。在肝移植后的短期(+8%)和长期(+22%)观察到脑室大小(脑室大小的间接测量)；脑室大小比健康对照组大。此外，在长期内检测到局灶性T2白质病变(小血管脑血管疾病的一个指标)体积的进展(+49%)，并且在那些增长较大的患者中与血管危险因素有关(>；每年12.5%)。肝移植术后神经心理功能有明显改善，除脑白质损害增加较多的患者记忆丧失外，其余患者长期保持稳定。成功的肝移植后神经心理功能的改善可长达9年。然而，这些患者经历了T2脑局灶性病变的进行性积累，并显示出比对照组更小的脑体积，这可能与他们以前的肝硬变有关。在移植前进行良好的管理以尽量减少脑损伤，并对血管危险因素进行准确的治疗，对于预防认知功能的后果可能是重要的。
Background. A prolonged survival in liver transplant recipients due to a better management exposes them to multiple factors that can impair neurologic function in the long term.Methods. Twenty-two patients were studied by brain magnetic resonance and completed a neuropsychologic assessment shortly before liver transplant, 6 to 12 months after (short term), and 6 to 9 years (long term) after liver transplant. Thirteen healthy controls matched by age were studied in parallel.Results. An enlargement in the ventricular size (an indirect measure of brain volume) was observed in the short term (+8%) and in the long term after liver transplant (+22%); the size of ventricles was larger than in healthy controls. In addition, a progression in the volume of focal T2 white matter lesions (an index of small vessel cerebrovascular disease) was detected in the long term (+49%) and was related to vascular risk factors in those with larger increases (>12.5% per year). Neuropsychologic function showed a significant improvement after liver transplant and remained stable in the long term, except for memory loss in those patients with larger increases in white matter lesions.Conclusions. Improvement in neuropsychologic function after successful liver transplant can be demonstrated up to 9 years. However, these patients experience a progressive accumulation of focal T2 brain lesions and show a smaller brain volume than controls, which can be related to their previous cirrhosis. A good management to minimize brain injury before transplantation and an accurate treatment of vascular risk factors may be important to prevent consequences on cognitive function.