Manninen D L, Evans R W, Dugan M K
Health and Population Research Center, Battelle-Seattle Research Center, Washington.
Clin Transpl. 1991:193-203.
A primary objective of renal replacement therapy is patient rehabilitation. Studies have consistently shown that transplant recipients are better rehabilitated than patients maintained on dialysis, but diabetic transplant recipients do not do as well as nondiabetics. Few studies have evaluated the rehabilitation status of transplant recipients based upon their outcome following transplantation. Data were collected from 226 patients associated with 5 major transplant centers in the United States at 2.5-3.5 years posttransplant. Established survey procedures were followed and standard measures of work status, functional ability, and health status were incorporated into self-administered questionnaires. Patients were stratified into 3 groups based upon transplant outcome--those with functioning grafts, those whose grafts failed and were retransplanted, and those who returned to dialysis after graft failure. The presence of diabetes was also documented. Regardless of graft outcome, more patients were able to work than were actually working (61.5% vs 43.4%), although patients with successful transplants, and those who were retransplanted, were both better able to work than patients whose grafts had failed, necessitating a return to dialysis. Diabetic and nondiabetic patients differed in their ability to work (74.4% vs 34.7%). All patient groups reported work-related limitations in activity and associated functional impairments. These were less severe for patients who had functioning grafts. Perceived as well as actual health status varied according to graft outcome and primary disease diagnosis, with both dialysis patients and diabetics reporting poorer health status than patients who had retained their first grafts or who had been retransplanted. Graft outcome and primary renal diagnosis prior to transplant are important predictors of ability to work, functional ability, and health status posttransplant. Retransplantation is not detrimental to patient rehabilitation, whereas return to dialysis results in a measurable decline in activity status. Despite a successful graft, diabetes severely limits the rehabilitation potential of transplant recipients.
肾脏替代治疗的一个主要目标是患者康复。研究一直表明，移植受者比接受透析治疗的患者康复情况更好，但糖尿病移植受者的康复情况不如非糖尿病患者。很少有研究根据移植后的结果评估移植受者的康复状况。在美国5个主要移植中心收集了226例患者移植后2.5至3.5年的数据。遵循既定的调查程序，并将工作状态、功能能力和健康状况的标准测量方法纳入自填式问卷中。根据移植结果将患者分为3组——移植肾有功能的患者、移植肾失败后再次移植的患者以及移植肾失败后恢复透析的患者。糖尿病的存在情况也有记录。无论移植结果如何，能够工作的患者比实际工作的患者更多（61.5%对43.4%），尽管移植成功的患者和再次移植的患者比移植肾失败而需要恢复透析的患者更有能力工作。糖尿病患者和非糖尿病患者在工作能力方面存在差异（74.4%对34.7%）。所有患者组都报告了与工作相关的活动限制和相关的功能损害。对于移植肾有功能的患者，这些限制和损害较轻。根据移植结果和原发性疾病诊断，患者自我感知的以及实际的健康状况各不相同，透析患者和糖尿病患者报告的健康状况比保留首次移植肾或再次移植的患者更差。移植结果和移植前的原发性肾脏诊断是移植后工作能力、功能能力和健康状况的重要预测指标。再次移植对患者康复没有不利影响，而恢复透析会导致活动状态出现可测量的下降。尽管移植成功，但糖尿病严重限制了移植受者的康复潜力。
