The role of liver transplantation in the treatment of hepatic myelopathy: case report with review of the literature.

BACKGROUND AND AIMS: Hepatic myelopathy (HM) is a rare neurological complication of chronic liver disease, causing progressive spastic paraparesis. Unlike hepatic encephalopathy, the conservative treatment of HM is usually considered inefficient. Although some scattered case studies have reported that the clinical symptoms and signs of patients with HM were improved after orthotopic liver transplantation (OLT), there have also been cases of failure. The aim of this study was to identify the role of OLT in the treatment of HM.

PATIENTS AND METHODS: We present two patients, who underwent OLT at the early stage after progressive HM had been diagnosed, gaining definite improvement of their neurological status within a relatively short time. In addition, we review all five similar cases that have hitherto been reported in English literature.

RESULTS: The clinical symptoms and signs of HM improved to variable degrees after OLT in most cases except one with a long HM history. The degree of improvement correlated with the time interval between the onset of the first symptoms of HM and OLT.

CONCLUSIONS: OLT represents an effective therapeutic option for HM. The duration of clinical manifestations of HM before OLT may be the main factor affecting the therapeutic outcome.