Reply to: “Chronic fatigue should not be overlooked in primary biliary cholangitis”

Abstract

To the Editor:We thank E. Shahini and F. Ahmed for their comments on our study of the long-term impact of preventive ursodeoxycholic acid (UDCA) therapy after liver transplantation for primary biliary cholangitis (PBC). 1,2 To the question "why Corpechot and colleagues did not examine in their work pre-and posttransplant fatigue amongst the various variables?" the answer is quite simple: our study was a non-interventional follow-up study based on retrospectively collected routine care data so that the capture of fatigue, a symptom rarely assessed with standardized validated tools in daily practice, was not feasible. We do not believe that the lack of consideration of this variable in this study could have had a significant influence on its results, specifically secondary outcomes, i.e. graft loss incidence and mortality, since all survival analyses (i.e. both Cox proportionalhazards and restricted mean survival time models) were controlled for the main established prognostic factors and confirmed by the multiple sensitivity analyses done. We do agree that fatigue in PBC is a common but very often under-estimated symptom that significantly impairs quality of life, but from our point of view its real impact on prognosis and more specifically all-cause mortality is questionable and still an open issue.