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Liver transplantation influences fatigue in patients with primary biliary cirrhosis

A study in the latest issue of the Journal of Hepatology investigates the effect of liver transplantation on fatigue in patients with primary biliary cirrhosis.

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The role of liver transplantation for the relief of fatigue in patients with primary primary biliary cirrhosis is unclear.

While many centers exclude fatigue as an indication for transplantation, there have been no studies to prospectively evaluate the impact of liver transplantation on fatigue.

Dr Marco Carbone and colleagues assessed the severity of fatigue in liver transplantation candidates with primary biliary cirrhosis and the impact of liver transplantation on fatigue.

In a prospective, longitudinal study, the team used the primary biliary cirrhosis-40 questionnaire in 49 adult patients with primary biliary cirrhosis at listing and at 6, 12, and 24 months after liver transplantation.

The team also assessed 2 sex- and age-matched cohorts of community controls, and non-transplanted primary biliary cirrhosis patients.

The calculated pooled gastric cancer incidence-rate was about 0.3% per person-years
Journal of Hepatology

Correlation analysis was used to assess the relationship between liver function and fatigue.

ANOVA was used to compare the variation of fatigue score before and after liver transplantation.

There was no correlation between MELD and fatigue before liver transplantation.

The doctors found that overall, the fatigue score after liver transplantation was substantially lower than before liver transplantation, falling from 41 pre-transplant to 28, 29, 26 at 6, 12, and 24 months after liver transplantation, respectively.

The same improvement of fatigue was observed in both low-MELD and high-MELD patients.

The team noted that improvement in fatigue was also evident in the comparison with a “non-transplant primary biliary cirrhosis” control group.

However, 44% of the total cohort, and 47% of those with low-MELD, for whom the probability of dying of liver transplantation may be higher than that of dying without liver transplantation, had moderate to severe fatigue at 2 years after liver transplantation.

Moreover, fatigue scores at 2 years were higher in the transplant primary biliary cirrhosis cohort compared to a cohort of community controls.

Dr Carbone's team concludes, "Liver transplantation is associated with improvement in fatigue in patients with primary biliary cirrhosis."

"However, a substantial proportion of patients continue to suffer from significant fatigue after two years."

"Whether the improvement is enough to justify organ allocation in patients with fatigue alone, without liver failure, is still an open issue."

"Certainly, in the era of organ shortage, with many patients dying waiting for a graft, this may not represent the optimal use of donated deceased organs."

J of Hepatol 2013: 59(3): 490-494
23 September 2013

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