Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom.
J Hepatol. 2013 Sep;59(3):490-4. doi: 10.1016/j.jhep.2013.04.017. Epub 2013 Apr 27.
BACKGROUND & AIMS: The role of liver transplantation (LT) for the relief of fatigue in patients with primary biliary cirrhosis (PBC) is unclear, and while many centers exclude fatigue as an indication for transplantation, there have been no studies to prospectively evaluate the impact of LT on fatigue. We aimed at assessing the severity of fatigue in LT candidates with PBC and the impact of LT on fatigue.
In a prospective, longitudinal study, we used the PBC-40 questionnaire in 49 adult patients with PBC at listing and at 6, 12, and 24 months after LT and in two sex- and age-matched cohorts of community controls and non-transplanted PBC patients. 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 LT.
There was no correlation between MELD and fatigue before LT (r(2)=0.01). Overall, the fatigue score after LT was substantially lower than before LT, falling from 40.7 ± 11.4 pre-transplant to 27.7 ± 9.5, 28.7 ± 10.1, 26.2 ± 10.1 (p<0.0001) at 6, 12, and 24 months after LT, respectively. The same improvement of fatigue was observed in both low-MELD (<17) and high-MELD (≥ 17) patients. Improvement in fatigue was also evident in the comparison with a "non-transplant PBC" control group (31.1 ± 11.6, p=0.03). However, 44% of the total cohort, and 47% of those with low-MELD, for whom the probability of dying of LT may be higher than that of dying without LT, had moderate to severe fatigue (defined as a fatigue score ≥ 29) at two years after LT. Moreover, fatigue scores at two years were higher in the transplant PBC cohort compared to a cohort of community controls (17.8 ± 5.9, p<0.0001).
Liver transplantation is associated with improvement in fatigue in patients with PBC. 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.
肝移植（LT）对原发性胆汁性肝硬化（PBC）患者缓解疲劳的作用尚不清楚，尽管许多中心将疲劳排除在移植适应证之外，但尚无前瞻性评估 LT 对疲劳影响的研究。我们旨在评估 PBC 肝移植候选者的疲劳严重程度以及 LT 对疲劳的影响。
在一项前瞻性纵向研究中，我们使用 PBC-40 问卷，在 49 名 PBC 成年患者 LT 前、LT 后 6、12 和 24 个月以及两个性别和年龄匹配的社区对照和非移植 PBC 患者队列中进行评估。采用相关分析评估肝功能与疲劳的关系。采用方差分析比较 LT 前后疲劳评分的变化。
MELD 与 LT 前的疲劳无相关性（r(2)=0.01）。总体而言，LT 后的疲劳评分明显低于 LT 前，分别从移植前的 40.7±11.4 降至 LT 后 6、12 和 24 个月的 27.7±9.5、28.7±10.1 和 26.2±10.1（p<0.0001）。低 MELD（<17）和高 MELD（≥17）患者的疲劳均有相同程度的改善。与“非移植 PBC”对照组（31.1±11.6，p=0.03）相比，疲劳也有明显改善。然而，在总队列中，44%，以及在低 MELD 队列中，47%，其因 LT 死亡的概率可能高于无 LT 死亡的概率，在 LT 后两年仍存在中重度疲劳（定义为疲劳评分≥29）。此外，移植 PBC 队列的疲劳评分在 2 年后高于社区对照组（17.8±5.9，p<0.0001）。
LT 可改善 PBC 患者的疲劳。然而，相当一部分患者在两年后仍持续遭受严重疲劳。疲劳的改善是否足以证明在没有肝衰竭的情况下，仅因疲劳而进行器官分配是合理的，这仍然是一个悬而未决的问题。当然，在器官短缺的时代，许多患者在等待供体时死亡，这可能不是对捐献的已故器官的最佳利用。
