Etiologia e risco da fadiga em pacientes transplantados hepáticos: uma revisão sistemática

Abstract

Liver transplantation is the latest treatment modality for acute and chronic liver diseases and currently contributes to a high survival rate, mainly due to the modernization of surgical techniques and constant innovation of immunosuppressants. In this way, quality of life becomes the target of professional care, mainly the relief of symptoms such as fatigue, which represents a health phenomenon present in the majority of liver transplant recipients, especially in the first months after transplantation and, in many cases, not showing improvement over time. Treatment of fatigue depends on identifying the factors that cause this clinical condition in any post-transplant period. In this context, we aim to systematically summarize the available evidence on the etiology and risk of fatigue in liver transplant patients. A systematic review of etiology and risk was carried out using the mnemonic PEO (Population, Exposure and Outcome) under the guidance of chapter 7 of the JBI manual, which addresses reviews of etiology and risk. 5,964 studies carried out with adults who underwent liver transplantation and who were at any stage of the post-operative period were included, whether they were cared for in an outpatient, hospital or at home setting. After reading and applying the criteria, 33 were included for full reading. At the end of the analyses, 6 cross-sectional studies were included. There was no time or language limit. Studies that presented a population with post-transplant complications and/or terminal illnesses were excluded. Two independent evaluators carried out article selection, data extraction and risk of bias analysis. Standardized JBI checklists were used to assess the risk of bias and methodological quality according to the designs of the included studies. The literature was divergent regarding the factors, but it was found that anxiety, depression, sleep quality and sex were linked to the incidence and/or intensity of fatigue. All studies have shown that fatigue is present after liver transplantation, often not decreasing over time, requiring more effective and targeted interventions from healthcare professionals. The protocol for this study was approved by the Prospective Register of Systematic Reviews (PROSPERO) with registration number CRD42023473186.