NIV Congres

Introduction Hepatic encephalopathy (HE) is a severe complication of liver cirrhosis. HE is not accounted for in the MELD score, which is widely being used for organ allocation. Aim of this study was to assess the impact of  encephalopathy on survival of patients awaiting liver transplantation.

Methods Retrospective analysis of consecutive adult patients listed for liver transplantation between 2007 and 2011 in a tertiary care centre.  Clinical data were retrieved from patient records and MELD and MELDNa score were calculated. Survival analysis was performed using Kaplan Meier and Cox proportional hazard regression analysis with death as event, censored for liver transplantation or last visit. Log-rank analysis was performed to exclude competing risk of transplantation. Univariate analysis was performed for presence of HE, MELD score, MELDNa score, age, ascites, prior SBP or variceal hemorrhage and hepatocellular carcinoma. Parameters with p<0.10 were included in multivariate analysis.

Results 168 Patients were included; 25/51 patients with HE (49%) and 64/117 (54%) patients without HE underwent liver transplantation after a mean of 7.0 ± 7.8 (HE) vs. 9.7 ± 7.8 months (no HE) (p= 0.158). HE patients had a higher MELD score at listing than patients without HE (20 ± 9 vs. 12 ± 5, p<0.001). The chance to receive a liver transplantation showed a trend towards earlier OLT in patients with HE (p=0.063). The presence of HE was independently associated with increased mortality before transplantation (HR 3.702 (95% CI 1.496-9.162), p=0.005), also after adjusting for MELD  and MELDNa score in multivariate analysis. MELD (HR 1.095 (95% CI 1.031-1.163), p=0.003) and MELDNa score (HR 1.124 (95% CI 1.051-1.202) were also independent predictors of mortality, whereas prior SBP and  ascites were not.  More severe HE was associated with a higher mortality risk, i.e.,  grade 2 HR 4.973 (p<0.001) grade 3-4  HR 28.413 (p<0.001). Mortality was not increased in patients with HE grade 1 (HR 1,094).

Conclusion Hepatic encephalopathy is an independent risk factor for mortality in patients awaiting liver transplantation. Objective biomarkers for assessment of HE are needed as HE patients might deserve higher priority.