Liver transplantation promotes early neural reorganization in minimal hepatic encephalopathy: a longitudinal resting state fMRI study.

This study longitudinally investigated LT's impact on cerebral function in MHE patients using rs-fMRI. Twenty patients underwent neuropsychological tests, clinical assessments and rs-fMRI before and one month after LT. Regional homogeneity (ReHo) and Granger causality analysis (GCA) were employed to evaluate alterations in local neural activity and effective connectivity before and after surgery. Pearson correlation analysis was conducted to examine the relationships between altered neural indices and clinical variables. After LT, ReHo in the left cuneus was significantly increased (p < 0.05). GCA revealed that the left cuneus exerted inhibitory effects on the bilateral superior frontal gyri, middle frontal gyri, right cingulate gyrus, and right precuneus, while the left cuneus experienced facilitatory effects from the right orbital middle frontal gyrus, left middle frontal gyrus, right middle occipital gyrus, and the cortex surrounding the right calcarine. The inhibitory connectivity from the left cuneus to the left middle frontal gyrus (r = 0.509, P = 0.022) and the facilitatory connectivity from the right middle occipital gyrus to the left cuneus (r = 0.468, P = 0.037) were positively correlated with improvements in liver function. These findings suggest LT-induced neural changes may underlie early cognitive recovery in MHE patients.