Hepatic encephalopathy (HE) is the most common neuropsychiatric complication in end-stage liver cirrhosis. Neurocognitive dysfunction in cirrhosis is associated with increased mortality, poorer quality of life, and deterioration of daily functioning. Liver transplantation (LT) is a powerful treatment that prolongs survival and improves life quality. However, it is unclear whether neurocognitive dysfunction is fully reversible or persists to some degree after LT. In this study, we evaluated brain activity changes in cirrhotic patients referred for LT by using resting-state functional MRI (rs-fMRI) with amplitude of low-frequency fluctuation (ALFF) algorithm.This study received institutional review board approval, and all subjects gave informed consent. Twenty cirrhotic patients as transplant candidates and 25 age-, gender-, and education-matched healthy controls were included. All the patients repeated the MRI study one month after LT. All cirrhotic patients had complete blood biochemistry tests (prothrombin time, total bilirubin and albumin) to evaluate liver function and venous blood ammonia values one week prior to MR scanning both before and after LT. Neuropsychological tests including the number connection test-A (NCT-A) and digit-symbol test (DST) were used to evaluate cognitive function of cirrhotic patients. The tests were conducted for all subjects just prior to the MR scan. The resting-state fMRI data were collected before and after surgery together with an MPRAGE scan as anatomical reference. All data were collected on a MAGNETOM Trio 3T MR scanner (Siemens Healthcare, Erlangen, Germany). The parameters of resting-state fMRI scan were as follows: TR=2000 ms, TE=30 ms, flip angle=90°, 33 slices, slice thickness=3.5 mm, distance factor=10%, FOV=192 ×192 mm2, matrix= 64×64, measurements=200. Amplitude of low-frequency fluctuation of each voxel were calculated using REST toolbox1 and then compared between cirrhotic patients (pre- and post-LT) and healthy controls as well as patients pre- and post-LT. Correlation analysis was performed to explore the relationship between the pre- and post-LT changes of ALFF and the changes of venous blood ammonia level and NCT-A/DST scores.In cirrhotic patients, decreased ALFF in visual association areas (left lingual gyrus and calcarine), sensorimotor association areas (left postcentral gyrus and middle cingulate cortex), and the default-mode network (bilateral precuneus and left inferior parietal lobule) can be reversed one month after LT, and the increased ALFF in temporal and frontal lobe can also be improved. The reduced ALFF in the right supplementary motor area, inferior parietal lobule and calcarine persisted in the early period after LT. In addition, one month after LT, the post-LT group showed decreased ALFF in the right pre-central gyrus (Fig.1-3). The changes of ALFF in the right precuneus were negatively correlated with changes of NCT-A (r=0.507, p<0.05) (Fig.4).In this resting-state functional MR imaging study, we found that most of the brain regions with altered ALFF could reverse one month after LT, suggesting that LT has a favorable effect on cirrhotic patients’ cognitive function. Nevertheless, the reduction of ALFF in some regions, such as right supplementary motor area, inferior parietal lobule and calcarine persisted in the early period after LT. Furthermore, at one month post-LT, there were new-onset ALFF decreases in the right precentral gyrus and increases in the left middle frontal gyrus and right inferior frontal gyrus. These findings imply that complete cognitive function restoration may need a longer time.The intrinsic brain activation measured by rs-fMRI could provide useful information for monitoring liver transplant surgery recovery outcomes.