In forthcoming years we propose to characterize latent (or subclinical) hepatic encephalopathy (HE) in alcoholics with cirrhosis, determine the reversibility of HE after orthotopic hepatic transplantation (TX), and clarify intra and extrahepatic mechanisms underlying this neuropsychiatric disorder. As part of ongoing effort to comprehensively characterize the alcoholic population undergoing hepatic TX, our investigations will evaluate physical fitness (endurance, cardiorespiratory efficiency, strength, etc.) before and one-year after surgery as it relates to survival, quality of life and neuropsychiatric status. Finally, because of the opportunity to access to a large pool of alcoholics undergoing hepatic TX, our research will explore the prognostic utility of demographic, neuropsychiatric, quality of life and physical fitness variables pre-TX for predicting drinking relapse post TX. Cirrhotic alcoholics (N=60) and cirrhotic nonalcoholics (N=60) will be studied before TX and one-year post TX. They will be compared to each other, to a medical control group (N=30), and to a normal control group (N=30) who are treated and retested at an equivalent one-year interval. The results obtained will further understanding of the nature and mechanisms of HE, its contribution to the neurologic disturbances observed commonly in alcoholics, and its potential for reversibility. In addition, the products of this research may have practical application for better identifying the physical rehabilitation needs of alcoholics before and following TX, facilitate selection of the most suitable candidates for TX, and accrue information which could maximize the quality of life in patients undergoing hepatic TX.

Agency
National Institute of Health (NIH)
Institute
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Type
Research Project (R01)
Project #
5R01AA006601-11
Application #
2389872
Study Section
Biochemistry, Physiology and Medicine Subcommittee (ALCB)
Project Start
1985-02-01
Project End
1999-03-31
Budget Start
1997-04-01
Budget End
1999-03-31
Support Year
11
Fiscal Year
1997
Total Cost
Indirect Cost
Name
University of Pittsburgh
Department
Psychiatry
Type
Schools of Medicine
DUNS #
053785812
City
Pittsburgh
State
PA
Country
United States
Zip Code
15213
Tarter, R E (1998) Quality of life following liver transplantation. Hepatogastroenterology 45:1398-403
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Tarter, R E; Panzak, G; Switala, J et al. (1997) Isokinetic muscle strength and its association with neuropsychological capacity in cirrhotic alcoholics. Alcohol Clin Exp Res 21:191-6
Tarter, R E; Switala, J; Lu, S et al. (1995) Abstracting capacity in cirrhotic alcoholics: negative findings. J Stud Alcohol 56:99-103
Salem, O; Dindzans, V J; Freeman, J et al. (1994) Liver transplantation following preoperative closure of intrapulmonary shunts. J Okla State Med Assoc 87:53-5
Trzepacz, P T; Tarter, R E; Shah, A et al. (1994) SPECT scan and cognitive findings in subclinical hepatic encephalopathy. J Neuropsychiatry Clin Neurosci 6:170-5
Kahn, D; Gavaler, J S; Makowka, L et al. (1993) Gender of donor influences outcome after orthotopic liver transplantation in adults. Dig Dis Sci 38:1485-8
Van Thiel, D H; Dindzans, V J; Schade, R R et al. (1993) Prophylactic versus emergency sclerotherapy of large esophageal varices prior to liver transplantation. Dig Dis Sci 38:1505-10
Tarter, R E; Switala, J; Plail, J et al. (1992) Severity of hepatic encephalopathy before liver transplantation is associated with quality of life after transplantation. Arch Intern Med 152:2097-101
Stauber, R E; Mochizuki, T; Van Thiel, D H et al. (1992) The use of quantitative scintigraphy in the measurement of portal-systemic shunting in rats. Ann Nucl Med 6:209-14

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