Why is this study being done?
Investigations of quality of life after transplantation have yielded key observations; however, quality of life tests poorly reflect neurocognitive outcome, which plays a critical role in post-transplant health. Neurocognitive dysfunction (NCD) after liver transplantation remains to be explored fully. In studies conducted by our group, that have included liver transplant patients, we have discovered that over half of patients admitted to surgical and medical ICUs develop delirium, an acute brain dysfunction that is an independent predictor of increased risk of death and NCD. We propose to study NCD after solid organ transplantation and determine the relationships between NCD and delirium as well as between NCD and functional MRI (fMRI) findings in a group of liver transplant patients.

Who is eligible to participate in the study?
All patients listed for liver transplantation who consent to the study are eligible.

What is involved with this study?
A NCD battery of tests will be administered to patients prior to transplantation and at 3 months and 12 months post-transplant. This battery takes 1-1.5 hours to administer. The NCD battery contains the following neuropsychological tests: 1) Global Cognitive Functioning – Extended Mini Mental State (3MS), (2) Executive Function – Trail Making B , (3) Mental Processing Speed – Digit Symbol Coding, (4) Memory – Rey-Osterrieth Complex Figure - Delayed Recall, Rey Auditory Verbal Learning Test , (5) Attention/Concentration – Trail Making A, Digit Span , (6) Visuo-Spatial Construction – Rey-Osterrieth Complex Figure - Copy , (7) Language – Controlled Oral Word Association Test (COWA).

The protocol for fMRI testing at 3 and 12 months is designed to determine if there are functional or morphological brain changes. High-resolution 3D MRI will be performed at the Vanderbilt Institute for Imaging Science. The Simon spatial incompatibility test and the N-back working memory test will then be performed to assess executive function and visual memory during the fMRI in accordance with well-established protocols