Reversibility of structural and functional alterations of hepatic encephalopathy

Hepatic Encephalopathy (HE) is a frequent complication of chronic liver disease. Type C HE mainly appears in episodes; only seldom chronic persistent forms occur. HE can lead to hospitalization and it has a huge impact on the health related quality of life. Symptoms of HE comprise alterations of the mental status and HE was associated with structural brain alterations. After the resolution of HE episodes alterations of the mental status seem to be reversible. However, cognitive impairment was described to persist in some patients in between HE episodes questioning the full reversibility of functional and structural alterations of HE. The causative treatment of chronic liver disease and subsequent HE episodes is liver transplantation. After liver transplantation functional and structural alterations caused by HE seem to be reversible, however, neurological complications in the first weeks after liver transplantation are frequent, especially in patients with a history of HE before transplantation. Furthermore, in patients in the long term after liver transplantation cognitive dysfunction was described. The underlying causes discussed are residual HE, side effects of immunosuppressive therapy and cerebrovascular disease besides others. It is an important question for patients and caregivers whether HE is a fully reversible episodic phenomenon or if it leads to persistent structural and functional brain alterations even after liver transplantation.