{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T11:02:45Z","timestamp":1791284565426,"version":"4.1.0"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","license":[{"start":{"date-parts":[[2015,6,26]],"date-time":"2015-06-26T00:00:00Z","timestamp":1435276800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2015,6,26]],"date-time":"2015-06-26T00:00:00Z","timestamp":1435276800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver Transpl"],"published-print":{"date-parts":[[2015,7]]},"abstract":"<jats:p>Hepatic encephalopathy (HE) is a surrogate marker of liver disease severity, and more severe HE is associated with higher mortality among patients with chronic liver disease. However, whether severity of HE at the time of liver transplantation (LT) directly impacts post\u2010LT survival or whether this suspected mortality linkage is due to more severe liver disease and subsequently higher rates of post\u2010LT infection is not well defined. Using population\u2010based data from the 2003 to 2013 United Network for Organ Sharing registry, we evaluated the impact of HE at the time of LT on post\u2010LT survival among adults in the United States. Survival was stratified by HE severity (none, grade 1\u20102, grade 3\u20104) and Model for End\u2010Stage Liver Disease score and was evaluated using Kaplan\u2010Meier methods and multivariate Cox proportional hazards models. From 2003 to 2013, 59,937 patients underwent LT (36.1%, no HE; 53.8%, grade 1\u20102 HE; 10.2%, grade 3\u20104 HE). Compared to no HE, patients with grade 3\u20104 HE had significantly lower overall post\u2010LT survival (1\u2010year, 82.5% versus 90.3%;<jats:italic toggle=\"yes\">P<\/jats:italic>\u2009&lt;\u20090.001; 5\u2010year, 69.1% versus 74.4%;<jats:italic toggle=\"yes\">P<\/jats:italic>\u2009&lt;\u20090.001). On multivariate regression, grade 3\u20104 HE was independently associated with lower overall post\u2010LT survival (HR, 1.27; 95% CI, 1.17\u20101.39;<jats:italic toggle=\"yes\">P<\/jats:italic>\u2009&lt;\u20090.001). However, the increased mortality associated with HE is observed primarily within the first year following LT and was a reflection of higher rates of infection\u2010related deaths among patients with more severe HE. In conclusion, grade 3\u20104 HE at the time of LT is associated with lower post\u2010LT survival, with a proposed direct or indirect association of more severe HE before LT with increased rates of post\u2010LT infections. Increased awareness and vigilance toward treating HE before LT and more aggressive monitoring and treatment for infections in the perioperative setting may improve LT outcomes.<jats:italic toggle=\"yes\">Liver Transpl 21:873\u2010880, 2015<\/jats:italic>. \u00a9 2015 AASLD.<\/jats:p>","DOI":"10.1002\/lt.24153","type":"journal-article","created":{"date-parts":[[2015,4,23]],"date-time":"2015-04-23T05:13:12Z","timestamp":1429765992000},"page":"873-880","source":"Crossref","is-referenced-by-count":37,"title":["The impact of pretransplant hepatic encephalopathy on survival following liver transplantation"],"prefix":"10.1097","volume":"21","author":[{"given":"Robert J.","family":"Wong","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Highland Hospital,Oakland,CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Aguilar","sequence":"additional","affiliation":[{"name":"Department of Medicine, Alameda Health System,Highland Hospital,Oakland,CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert G.","family":"Gish","sequence":"additional","affiliation":[{"name":"Hepatitis B Foundation,Doylestown,PA"},{"name":"Division of Gastroenterology and Hepatology,Stanford University School of Medicine,Stanford,CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramsey","family":"Cheung","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Stanford University School of Medicine,Stanford,CA"},{"name":"Division of Gastroenterology and Hepatology,Veterans Affairs Palo Alto Health Care System,Palo Alto,CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aijaz","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Stanford University School of Medicine,Stanford,CA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2015,6,26]]},"reference":[{"key":"lt24153-bib-0001-20240115","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1053\/gast.2003.50016","article-title":"Model for End\u2010Stage Liver Disease (MELD) and allocation of donor livers","volume":"124","year":"2003","journal-title":"Gastroenterology"},{"key":"lt24153-bib-0002-20240115","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1053\/jhep.2001.22172","article-title":"A model to predict survival in patients with end\u2010stage liver disease","volume":"33","year":"2001","journal-title":"Hepatology"},{"key":"lt24153-bib-0003-20240115","doi-asserted-by":"crossref","first-page":"1454","DOI":"10.1002\/lt.23981","article-title":"Hepatic encephalopathy is associated with significantly increased mortality among patients awaiting liver transplantation","volume":"20","year":"2014","journal-title":"Liver 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