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.
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