Recovery from hepatic retinopathy after liver transplantation

Background. In chronic liver disease the neuroglial cells may be affected by neurotoxic metabolites which, in turn, could be expected to affect neuronal functions. The aim of this study was to evaluate the electroretinograms (ERG) from patients before and after liver transplantation, in order to study possible functional changes of the retina. Methods. Twelve patients with liver cirrhosis underwent routine ophthalmological examination and ERG before and after successful liver transplantation. Laboratory parameters, including ammonia, aspartate aminotransferase (AST), bilirubin, and cholinesterase, were compared. Patients were grouped according to the Child classification: three patients were Child A, six were Child B, three were Child C. Results. Most obvious ERG abnormalities were found in patients with cirrhosis Child C. Before transplantation 7 of 21 ERG parameters were out of the normal range, but in the follow-up examination after transplantation only one parameter was not within the normal range. Significant (P<0.05) postoperative improvements were found for the latencies of scotopic, mesopic and photopic b-waves and mesopic a-waves and for the photopic implicit time. Patients in the Child B group revealed less changes in the ERG. Before the transplantation only one parameter of the ERG was out of the normal range. All postoperative parameters were within the normal range. At 40+/-9 months after the liver transplantation a significant decrease in serum ammonia levels, AST and bilirubin and a significant increase in cholinesterase levels were observed. Conclusion. Patients with restored liver function after liver transplantation showed significantly improved ERG parameters. Our data suggest a recovery of the cells involved in hepatic retinopathy, including the Muller (glial) cells.