title: Persistent fatigue in liver transplant recipients: a two-year follow-up study.
abstract: BACKGROUND
  Fatigue after liver transplantation (LTx) is a major problem that is associated with lower daily functioning and health-related quality of life (HRQoL). This study aimed to assess changes over time in fatigue following LTx. We also examined daily functioning and HRQoL changes over time and assessed the influence of fatigue and changes in fatigue on daily functioning and HRQoL. We determined whether sleep quality, anxiety, and depression were associated with fatigue.
  
  
  METHODS
  We identified 70 LTx recipients who had previously participated in a cross-sectional study and reassessed them after two yr to determine changes in level of fatigue, daily functioning, and HRQoL. We also assessed sleep quality, anxiety, and depression after two yr.
  
  
  RESULTS
  Level of fatigue and level of daily functioning were unchanged at follow-up. HRQoL domains remained stable or worsened. Fatigue was a significant predictor of daily functioning and all HRQoL domains (p < 0.01). Change in fatigue was a significant predictor of daily functioning and the HRQoL domains of "physical functioning,""vitality," and "pain" (p < 0.05). Sleep quality, anxiety, and depression were associated with fatigue severity (r = 0.35 to r = 0.60, p < 0.05).
  
  
  CONCLUSIONS
  This longitudinal study shows that fatigue is a chronic problem after LTx and that daily functioning and HRQoL do not improve over time. This study supports the need for intervention programs to address fatigue after LTx.
authors.affiliation: Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands. b.vanginneken@erasmusmc.nl
authors.forename: Berbke T J
authors.initials: BT
authors.lastname: van Ginneken
authors.forename: Rita J G
authors.initials: RJ
authors.lastname: van den Berg-Emons
authors.forename: Anna
authors.initials: A
authors.lastname: van der Windt
authors.forename: Huug W
authors.initials: HW
authors.lastname: Tilanus
authors.forename: Herold J
authors.initials: HJ
authors.lastname: Metselaar
authors.forename: Henk J
authors.initials: HJ
authors.lastname: Stam
authors.forename: Geert
authors.initials: G
authors.lastname: Kazemier
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000453:epidemiology; D003866:Depressive Disorder / Q000453:epidemiology; D005221:Fatigue / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008107:Liver Diseases / Q000523:psychology* / Q000601:surgery*; D016031:Liver Transplantation; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012893:Sleep Wake Disorders / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome