Malaise and fatigue 2 years post transplant

Hello Dr. Schiano:

I had two liver transplants (Aug and Sep 2009) and am now on Prograf and Cellcept twice daily, also Ursodiol.  My liver disease was cryptogenic / autoimmune, possibly viral.  In the past I had Hodgkins Lymphoma twice, treated by chemotherapy (1997 and 2004-5).  My question is how common it is to experience prolongued malaise, bordering on depression, and fatigue, post-transplant.  My physical state is pretty good but I can't seem to kick the blues.  It is a daily struggle, and it is very unlike my pre-transplant self.  Could this be a side effect of the anti-rejection drugs?  I also get shingles every two months or so, obviously as a result of being auto-immune suppressed.  Could this also cause depression -- or could this be a post-traumatic disorder?

[Thomas D Schiano, MD]

it is not unusual for patients to have such complaints post-liver transplantation.  You can be feeling in this way for any of the number of reasons that you list.  The great majority of patients are somewhat anemic related to the meds and especially prograf can affect one's emotional state--these can be contributing