Liver transplantation reduced fatigue among patients with primary biliary cirrhosis

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Carbone M. J Hepatol. 2013;doi:10.1016/j.jhep.2013.04.017.

May 14, 2013

Patients with primary biliary cirrhosis who underwent liver transplantation experienced a significant and persistent reduction in fatigue symptoms, although almost half continued to experience fatigue in a recent study.

Researchers administered a 40-item quality of life questionnaire to 49 adult liver transplant (LT) recipients with primary biliary cirrhosis (PBC), along with 31 matched controls without PBC and 124 patients with PBC who did not undergo LT (n=124). Questionnaires were completed at baseline and at 6, 12 and 24 months after LT. Fatigue responses were evaluated, with scores of 11 or lower indicating no fatigue, 12-28 mild, 29-39 moderate and 40 or greater severe fatigue.

Among 31 evaluable patients who underwent LT, lower fatigue scores were observed post-transplant during follow-up (40.7 ± 11.4 vs. 27.7 ± 9.5 at 6 months, 28.7 ± 10.1 at 12 months and 26.2 ± 10.1 at 24 months post-transplant; P<.0001). This improvement occurred regardless of MELD score, and fatigue scores also were better among transplant recipients compared with nonrecipients with PBC (31.1 ± 11.6; P=.03). Scores at 24 months, however, were higher among transplant recipients than controls without PBC (17.8 ± 5.9; P<.0001).

Moderate to severe fatigue (scores of 29 or greater) was observed in 44% of the cohort, including 47% of patients with low MELD scores, at 24 months. Severe fatigue was observed in 12% of LT recipients at 12 months and 6% at 24 months post-transplant.

“We have shown that fatigue improves after LT,” the researchers concluded. “However, almost half of the patients fatigued before transplant remained significantly fatigued at 2 years after transplant. … These findings raise concerns regarding the appropriateness of transplantation as a treatment modality for fatigue alone in PBC, balanced against the real risk of mortality and morbidity from the transplant procedure itself. With improving long-term transplantation outcomes, we should focus more on the long-term improvement of the quality of life after LT. Further studies on fatigue in transplant recipients … are clearly warranted in order to confirm these findings.

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