Liver Recipients Are Not Sick But Tired

[Guest guest]

ROTTERDAM, The

Netherlands, June 2 — Two-thirds of liver transplant recipients complain

of constant physical fatigue, and nearly half say they are severely fatigued,

researchers here reported.

The

feeling of physical exhaustion persisted up to 15 years after transplantation,

and did not appear to lessen over time, wrote Rita van den Berg-Emons, Ph.D., of Erasmus Medical Center here, and

colleagues.

" Liver

transplant recipients experience physical fatigue and reduced activity rather

than mental fatigue and reduced motivation, " the investigators wrote in

the June issue of Liver Transplantation.

" These findings imply that rehabilitation programs, focusing on improving

activity patterns and physical fitness, may reduce complaints of fatigue after

liver transplantation. "

They

conducted a cross-sectional looking at the severity of fatigue in 96 patients

who had undergone liver transplantation an average of 4.5 years previously

(range 52 days to 15.4 years).

They also

assessed the nature of the fatigue itself — physical or mental —

and tried to determine its source.

To

measure and evaluate exhaustion, the investigators used two validated

instruments: the Fatigue Severity Scale and the Multidimensional Fatigue

Inventory. They also considered variables such as age, gender, indication for

transplantation, time since transplantation, immunosuppressive medication,

patient-reported disability, and health-related quality-of-life measures.

They

found that 66% of patients were fatigued, as measured by a Fatigue Severity

Scale score of 4.0 or more, and 44% were rated as being severely fatigued, with

a score of 5.1 or more.

When the

authors looked at the nature of the fatigue as assessed by the Multidimensional

Fatigue Inventory, a 20-item self-reported scale, they found that the patients

had significantly higher scores (indicating more fatigue) on the physical

fatigue and reduced activity subscales of the inventory than on either the

reduced motivation or mental fatigue subscales.

Among the

variables that significantly correlated with Fatigue Severity Scale score were

age and gender, with women having more fatigue than men, and, not surprisingly,

older liver graft recipients having more fatigue than younger recipients. The

mean age of recipients was 51.8 (+ 12.7) years.

" Without

adjustment for gender and age, time since transplantation, self-experienced

disabilities, and health-related quality of life were significantly correlated

with the severity of fatigue, " the authors wrote.

But when

they adjusted for both gender and age, they found that the relationship between

time since transplantation and severity of fatigue was no longer significant.

They did not find any associations between indication for liver transplantation

or immunosuppressive medication and severity of fatigue.

" A

previous study by our group using an activity monitor demonstrated that

fatigued liver transplant recipients have a sedentary lifestyle, " the

investigators wrote. " These findings imply that fatigue after liver transplantation

might be reduced with rehabilitation programs focusing on improving activity

patterns and physical fitness. "

In an

accompanying editorial, Jayant A. Talwalkar,

M.D., M.P.H. of the Mayo Clinic in Rochester,

Minn., noted that the Dutch investigators

did not look at psychological assessments of the patients or consider the roles

that anxiety and depression might play in causing fatigue in transplant

recipients.

" Depression

is common in patients with chronic liver disease and confounds the relationship

between fatigue and health-related quality of life, " he wrote.

" Similar interactions can occur in liver transplant recipients yet data on

the frequency of psychiatric disturbance after liver transplant are

scant. "

Dr. van

den Berg-Emons and colleagues are investigating

relationships between severity of fatigue and depression, anxiety, sleep

quality, complications after transplantation, and physical fitness of the

recipient, they reported.

Barb

in Texas - Together in the Fight, Whatever it Takes!

Son

Ken (32) UC 91 - PSC 99

[Guest guest]

Does anybody know how to take the tests noted below...Fatigue

Severity Scale and Multidimensional Fatigue Inventory ... I often

wonder how much of my fatigue (without a transplant) is physical

versus emotional...

which also reminds me - what is the " sleep disturbance " associated

with PSC - my docs always ask that and I don't sleep well, but I'm

interested in how sleep problems manifests with others...I find I'm

EXHAUSTED and then can't sleep, and always wake up exhausted and

don't " Wake up " until I drink cafeine and take a hot shower,

otherwise I'm foggy all day long...

Thanks

Barbara in MD

> To measure and evaluate exhaustion, the investigators used two

validated

> instruments: the Fatigue Severity Scale and the Multidimensional

Fatigue

> Inventory. They also considered variables such as age, gender,

> indication for transplantation, time since transplantation,

> immunosuppressive medication, patient-reported disability, and

> health-related quality-of-life measures.

> They found that 66% of patients were fatigued, as measured by a

Fatigue

> Severity Scale score of 4.0 or more, and 44% were rated as being

> severely fatigued, with a score of 5.1 or more.

> When the authors looked at the nature of the fatigue as assessed

by the

> Multidimensional Fatigue Inventory, a 20-item self-reported scale,

they

> found that the patients had significantly higher scores

(indicating more

> fatigue) on the physical fatigue and reduced activity subscales of

the

> inventory than on either the reduced motivation or mental fatigue

> subscales.

> Among the variables that significantly correlated with Fatigue

Severity

> Scale score were age and gender, with women having more fatigue

than

> men, and, not surprisingly, older liver graft recipients having

more

> fatigue than younger recipients. The mean age of recipients was

51.8 (+

> 12.7) years.

> " Without adjustment for gender and age, time since transplantation,

> self-experienced disabilities, and health-related quality of life

were

> significantly correlated with the severity of fatigue, " the authors

> wrote.

> But when they adjusted for both gender and age, they found that the

> relationship between time since transplantation and severity of

fatigue

> was no longer significant. They did not find any associations

between

> indication for liver transplantation or immunosuppressive

medication and

> severity of fatigue.

> " A previous study by our group using an activity monitor

demonstrated

> that fatigued liver transplant recipients have a sedentary

lifestyle, "

> the investigators wrote. " These findings imply that fatigue after

liver

> transplantation might be reduced with rehabilitation programs

focusing

> on improving activity patterns and physical fitness. "

> In an accompanying editorial, Jayant A. Talwalkar, M.D., M.P.H. of

the

> Mayo Clinic in Rochester, Minn., noted that the Dutch

investigators did

> not look at psychological assessments of the patients or consider

the

> roles that anxiety and depression might play in causing fatigue in

> transplant recipients.

> " Depression is common in patients with chronic liver disease and

> confounds the relationship between fatigue and health-related

quality of

> life, " he wrote. " Similar interactions can occur in liver

transplant

> recipients yet data on the frequency of psychiatric disturbance

after

> liver transplant are scant. "

> Dr. van den Berg-Emons and colleagues are investigating

relationships

> between severity of fatigue and depression, anxiety, sleep quality,

> complications after transplantation, and physical fitness of the

> recipient, they reported.

>

> Barb in Texas - Together in the Fight, Whatever it Takes!

> Son Ken (32) UC 91 - PSC 99

>

[Guest guest]

Does anybody know how to take the tests noted below...Fatigue

Severity Scale and Multidimensional Fatigue Inventory ... I often

wonder how much of my fatigue (without a transplant) is physical

versus emotional...

which also reminds me - what is the " sleep disturbance " associated

with PSC - my docs always ask that and I don't sleep well, but I'm

interested in how sleep problems manifests with others...I find I'm

EXHAUSTED and then can't sleep, and always wake up exhausted and

don't " Wake up " until I drink cafeine and take a hot shower,

otherwise I'm foggy all day long...

Thanks

Barbara in MD

> To measure and evaluate exhaustion, the investigators used two

validated

> instruments: the Fatigue Severity Scale and the Multidimensional

Fatigue

> Inventory. They also considered variables such as age, gender,

> indication for transplantation, time since transplantation,

> immunosuppressive medication, patient-reported disability, and

> health-related quality-of-life measures.

> They found that 66% of patients were fatigued, as measured by a

Fatigue

> Severity Scale score of 4.0 or more, and 44% were rated as being

> severely fatigued, with a score of 5.1 or more.

> When the authors looked at the nature of the fatigue as assessed

by the

> Multidimensional Fatigue Inventory, a 20-item self-reported scale,

they

> found that the patients had significantly higher scores

(indicating more

> fatigue) on the physical fatigue and reduced activity subscales of

the

> inventory than on either the reduced motivation or mental fatigue

> subscales.

> Among the variables that significantly correlated with Fatigue

Severity

> Scale score were age and gender, with women having more fatigue

than

> men, and, not surprisingly, older liver graft recipients having

more

> fatigue than younger recipients. The mean age of recipients was

51.8 (+

> 12.7) years.

> " Without adjustment for gender and age, time since transplantation,

> self-experienced disabilities, and health-related quality of life

were

> significantly correlated with the severity of fatigue, " the authors

> wrote.

> But when they adjusted for both gender and age, they found that the

> relationship between time since transplantation and severity of

fatigue

> was no longer significant. They did not find any associations

between

> indication for liver transplantation or immunosuppressive

medication and

> severity of fatigue.

> " A previous study by our group using an activity monitor

demonstrated

> that fatigued liver transplant recipients have a sedentary

lifestyle, "

> the investigators wrote. " These findings imply that fatigue after

liver

> transplantation might be reduced with rehabilitation programs

focusing

> on improving activity patterns and physical fitness. "

> In an accompanying editorial, Jayant A. Talwalkar, M.D., M.P.H. of

the

> Mayo Clinic in Rochester, Minn., noted that the Dutch

investigators did

> not look at psychological assessments of the patients or consider

the

> roles that anxiety and depression might play in causing fatigue in

> transplant recipients.

> " Depression is common in patients with chronic liver disease and

> confounds the relationship between fatigue and health-related

quality of

> life, " he wrote. " Similar interactions can occur in liver

transplant

> recipients yet data on the frequency of psychiatric disturbance

after

> liver transplant are scant. "

> Dr. van den Berg-Emons and colleagues are investigating

relationships

> between severity of fatigue and depression, anxiety, sleep quality,

> complications after transplantation, and physical fitness of the

> recipient, they reported.

>

> Barb in Texas - Together in the Fight, Whatever it Takes!

> Son Ken (32) UC 91 - PSC 99

>

[Guest guest]

Does anybody know how to take the tests noted below...Fatigue

Severity Scale and Multidimensional Fatigue Inventory ... I often

wonder how much of my fatigue (without a transplant) is physical

versus emotional...

which also reminds me - what is the " sleep disturbance " associated

with PSC - my docs always ask that and I don't sleep well, but I'm

interested in how sleep problems manifests with others...I find I'm

EXHAUSTED and then can't sleep, and always wake up exhausted and

don't " Wake up " until I drink cafeine and take a hot shower,

otherwise I'm foggy all day long...

Thanks

Barbara in MD

> To measure and evaluate exhaustion, the investigators used two

validated

> instruments: the Fatigue Severity Scale and the Multidimensional

Fatigue

> Inventory. They also considered variables such as age, gender,

> indication for transplantation, time since transplantation,

> immunosuppressive medication, patient-reported disability, and

> health-related quality-of-life measures.

> They found that 66% of patients were fatigued, as measured by a

Fatigue

> Severity Scale score of 4.0 or more, and 44% were rated as being

> severely fatigued, with a score of 5.1 or more.

> When the authors looked at the nature of the fatigue as assessed

by the

> Multidimensional Fatigue Inventory, a 20-item self-reported scale,

they

> found that the patients had significantly higher scores

(indicating more

> fatigue) on the physical fatigue and reduced activity subscales of

the

> inventory than on either the reduced motivation or mental fatigue

> subscales.

> Among the variables that significantly correlated with Fatigue

Severity

> Scale score were age and gender, with women having more fatigue

than

> men, and, not surprisingly, older liver graft recipients having

more

> fatigue than younger recipients. The mean age of recipients was

51.8 (+

> 12.7) years.

> " Without adjustment for gender and age, time since transplantation,

> self-experienced disabilities, and health-related quality of life

were

> significantly correlated with the severity of fatigue, " the authors

> wrote.

> But when they adjusted for both gender and age, they found that the

> relationship between time since transplantation and severity of

fatigue

> was no longer significant. They did not find any associations

between

> indication for liver transplantation or immunosuppressive

medication and

> severity of fatigue.

> " A previous study by our group using an activity monitor

demonstrated

> that fatigued liver transplant recipients have a sedentary

lifestyle, "

> the investigators wrote. " These findings imply that fatigue after

liver

> transplantation might be reduced with rehabilitation programs

focusing

> on improving activity patterns and physical fitness. "

> In an accompanying editorial, Jayant A. Talwalkar, M.D., M.P.H. of

the

> Mayo Clinic in Rochester, Minn., noted that the Dutch

investigators did

> not look at psychological assessments of the patients or consider

the

> roles that anxiety and depression might play in causing fatigue in

> transplant recipients.

> " Depression is common in patients with chronic liver disease and

> confounds the relationship between fatigue and health-related

quality of

> life, " he wrote. " Similar interactions can occur in liver

transplant

> recipients yet data on the frequency of psychiatric disturbance

after

> liver transplant are scant. "

> Dr. van den Berg-Emons and colleagues are investigating

relationships

> between severity of fatigue and depression, anxiety, sleep quality,

> complications after transplantation, and physical fitness of the

> recipient, they reported.

>

> Barb in Texas - Together in the Fight, Whatever it Takes!

> Son Ken (32) UC 91 - PSC 99

>

[Guest guest]

Barbara Webber wrote:

> Does anybody know how to take the tests noted below...Fatigue

> Severity Scale and Multidimensional Fatigue Inventory ... I often

> wonder how much of my fatigue (without a transplant) is physical

> versus emotional...

You can find the first test at:

http://www.mult-sclerosis.org/fatigueseverityscale.html

I'm still looking for the other one; there are plenty of articles

telling about it, but I've not yet located the actual test.

Regards,

Carolyn B. in SC

[Guest guest]

Barbara Webber wrote:

> Does anybody know how to take the tests noted below...Fatigue

> Severity Scale and Multidimensional Fatigue Inventory ... I often

> wonder how much of my fatigue (without a transplant) is physical

> versus emotional...

You can find the first test at:

http://www.mult-sclerosis.org/fatigueseverityscale.html

I'm still looking for the other one; there are plenty of articles

telling about it, but I've not yet located the actual test.

Regards,

Carolyn B. in SC

[Guest guest]

Barbara Webber wrote:

> Does anybody know how to take the tests noted below...Fatigue

> Severity Scale and Multidimensional Fatigue Inventory ... I often

> wonder how much of my fatigue (without a transplant) is physical

> versus emotional...

You can find the first test at:

http://www.mult-sclerosis.org/fatigueseverityscale.html

I'm still looking for the other one; there are plenty of articles

telling about it, but I've not yet located the actual test.

Regards,

Carolyn B. in SC

[Guest guest]

>

> > Does anybody know how to take the tests noted below...Fatigue

> > Severity Scale and Multidimensional Fatigue Inventory >

>

> You can find the first test at:

> http://www.mult-sclerosis.org/fatigueseverityscale.html

The CFIDS Association of America (CFIDS = chronic fatigue and immune

dysfunction syndrome) has a discussion of fatigue assessment with

another copy of the Fatigue Severity Scale at

http://www.cfids.org/archives/2002rr/2002-rr4-article02.asp

They also have a 4 question sample of the 20 question Multidimensional

Fatigue Inventory at http://www.cfids.org/treatcfs/pdf/mfi-20.pdf

Tim R

[Guest guest]

>

> > Does anybody know how to take the tests noted below...Fatigue

> > Severity Scale and Multidimensional Fatigue Inventory >

>

> You can find the first test at:

> http://www.mult-sclerosis.org/fatigueseverityscale.html

The CFIDS Association of America (CFIDS = chronic fatigue and immune

dysfunction syndrome) has a discussion of fatigue assessment with

another copy of the Fatigue Severity Scale at

http://www.cfids.org/archives/2002rr/2002-rr4-article02.asp

They also have a 4 question sample of the 20 question Multidimensional

Fatigue Inventory at http://www.cfids.org/treatcfs/pdf/mfi-20.pdf

Tim R