Fiebiger Wolfgang, Mitterbauer Christa, Oberbauer Rainer
Departments of Internal Medicine I and III, Division of Oncology, University of Vienna, Austria.
Health Qual Life Outcomes. 2004 Jan 8;2:2. doi: 10.1186/1477-7525-2-2.
With the improvements in short and long term graft and patient survival after renal transplantation over the last two decades Health-Related Quality of Life (HRQL) is becoming an important additional outcome parameter. Global and disease specific instruments are available to evaluate objective and subjective QOL. Among the most popular global tools is the SF-36, examples of disease specific instruments are the Kidney Transplant Questionnaire (KTQ), the Kidney Disease Questionnaire (KDQ) and the Kidney Disease-Quality of Life (KDQOL). It is generally accepted that HRQL improves dramatically after successful renal transplantation compared to patients maintained on dialysis treatment but listed for a transplant. It is less clear however which immunosuppressive regimen confers the best QOL. Only few studies compared the different regimens in terms of QOL outcomes. Although limited in number, these studies seem to favour non-cyclosporine based protocols. The main differences that could be observed between patients on cyclosporine versus tacrolimus or sirolimus therapy concern the domains of appearance and fatigue. This may be explained by two common adverse effects occurring under cyclosporine therapy, gingival hyperplasia and hair growth. Another more frequently occurring side effect under calcineurin inhibitor therapy is tremor, which may favour CNI free protocols. This hypothesis, however, has not been formally evaluated in a randomised trial using HRQL measurements.In summary HRQL is becoming more of an issue after renal transplantation. Whether a specific immunosuppressive protocol is superior to others in terms of HRQL remains to be determined.
在过去二十年中，随着肾移植术后短期和长期移植物及患者生存率的提高，健康相关生活质量（HRQL）正成为一个重要的额外结局参数。有全球通用和针对特定疾病的工具可用于评估客观和主观生活质量。最常用的全球通用工具之一是SF - 36，针对特定疾病的工具示例包括肾移植问卷（KTQ）、肾脏疾病问卷（KDQ）和肾脏疾病生活质量问卷（KDQOL）。人们普遍认为，与接受透析治疗但等待移植的患者相比，成功进行肾移植后HRQL会显著改善。然而，哪种免疫抑制方案能带来最佳生活质量尚不清楚。只有少数研究在生活质量结局方面比较了不同的方案。尽管数量有限，但这些研究似乎倾向于非环孢素方案。在接受环孢素治疗与他克莫司或西罗莫司治疗的患者之间观察到的主要差异涉及外貌和疲劳领域。这可能由环孢素治疗下出现的两种常见不良反应，即牙龈增生和毛发生长来解释。钙调神经磷酸酶抑制剂治疗下另一种更常见的副作用是震颤，这可能有利于无钙调神经磷酸酶抑制剂方案。然而，这一假设尚未在使用HRQL测量的随机试验中得到正式评估。总之，肾移植后HRQL正变得越来越重要。就HRQL而言，特定的免疫抑制方案是否优于其他方案仍有待确定。
