Translational Medicine Group, Pomeranian Medical University in Szczecin, Szczecin, Poland.
Department of Radiology, Medical University of Warsaw, Warsaw, Poland.
Liver Transpl. 2021 Jul;27(7):1032-1040. doi: 10.1002/lt.26033. Epub 2021 Apr 21.
Chronic fatigue and an impairment of general health-related quality of life (HRQoL) are frequently reported by patients with primary sclerosing cholangitis (PSC). Studies on patients with primary biliary cholangitis (PBC) suggest that, unlike pruritus, fatigue may not be ameliorated by liver transplantation (LT). However, there are few data regarding the assessment of fatigue before and after transplantation in PSC. To investigate the effect of LT on fatigue and HRQoL in patients with PSC, 81 patients with PSC (median age 33 years; 69% men) were prospectively enrolled in this study. The PBC-40 and Short Form 36 (SF-36) questionnaires were used for assessment before and twice after LT. A total of 26 patients who received a transplant for PBC were included as controls. The potential impact of the clinical and laboratory parameters was evaluated by univariate and multivariate analyses. Although in addition to other well-being indexes the median fatigue score improved after LT (P < 0.001), a detailed analysis demonstrated that fatigue persists in one-third of patients. A significant fatigue reduction was seen in men (P < 0.001) but not women (P = 0.25). Posttransplant fatigue did not depend on concomitant inflammatory bowel disease, laboratory indexes of cholestasis, or disease recurrence. In the multivariate regression model, female sex was the only independent covariate associated with persistent fatigue. In terms of other measures of HRQoL, LT caused a substantial improvement in the majority of SF-36 and PBC-40 domains. Recurrent PSC and unemployment negatively affected the well-being of patients. Patients who received a transplant for PSC had significantly better HRQoL than those patients with PBC. LT improves various measures of HRQoL, but it does not ameliorate fatigue in female patients with PSC.
原发性硬化性胆管炎（PSC）患者常报告慢性疲劳和一般健康相关生活质量（HRQoL）受损。对原发性胆汁性胆管炎（PBC）患者的研究表明，与瘙痒不同，疲劳可能不会因肝移植（LT）而改善。然而，关于 PSC 患者移植前后疲劳评估的数据很少。为了研究 LT 对 PSC 患者疲劳和 HRQoL 的影响，前瞻性纳入 81 例 PSC 患者（中位年龄 33 岁；69%为男性）。使用 PBC-40 和 36 项简短健康调查问卷（SF-36）在 LT 前后两次进行评估。共纳入 26 例因 PBC 接受移植的患者作为对照。通过单变量和多变量分析评估临床和实验室参数的潜在影响。尽管除其他幸福感指标外，LT 后疲劳评分中位数有所改善（P < 0.001），但详细分析表明，仍有三分之一的患者存在疲劳。男性（P < 0.001）而非女性（P = 0.25）疲劳显著减轻。移植后疲劳与并存的炎症性肠病、胆汁淤积的实验室指标或疾病复发无关。在多变量回归模型中，女性是与持续性疲劳相关的唯一独立协变量。在其他 HRQoL 测量方面，LT 导致大多数 SF-36 和 PBC-40 领域的显著改善。PSC 复发和失业对患者的幸福感产生负面影响。接受 PSC 移植的患者的 HRQoL 明显好于患有 PBC 的患者。LT 可改善 HRQoL 的各个方面，但不能改善女性 PSC 患者的疲劳。
