Monash University School of Psychology, Psychiatry and Psychological Medicine and Consultation-Liaison Psychiatry Service, Monash Medical Centre, Clayton, VIC, Australia.
Am J Kidney Dis. 2010 Apr;55(4):698-707. doi: 10.1053/j.ajkd.2009.12.025. Epub 2010 Feb 21.
Few risk factors for quality-of-life outcomes of simultaneous pancreas and kidney transplant recipients are known because of a paucity of data from prospective studies.
Pretransplant assessment and prospective 3-year follow-up.
SETTING & PARTICIPANTS: Consecutive potential recipients at a university teaching hospital assessed by Liaison Psychiatry.
Demographic data; pretransplant Transplant Evaluation Rating Scale scores; current, past 12 months, and prior lifetime psychiatric disorder.
OUTCOMES & MEASUREMENTS: 36-Item Short Form Health Survey (SF-36) scores.
37 simultaneous pancreas and kidney transplant recipients were assessed pretransplant and at 4 months posttransplant. Posttransplant at 1 year, 29 (81% of survivors); at 2 years, 26 (79% of survivors and those reaching 2 years); and at 3 years, 22 (92% of survivors and those reaching 3 years) patients were assessed. SF-36 Mental Component Summary (MCS) scores (mean pretransplant, 46.8 +/- 8.2 [SD]; 4 months, 51.7 +/- 8.5; 1 year, 50.1 +/- 9.7; 2 years, 51.8 +/- 8.9; and 3 years, 50.8 +/- 13.8) and Physical Component Summary (PCS) scores (pretransplant, 40.6 +/- 10.6; 4 months, 43.6 +/- 12.0; 1 year, 45.6 +/- 11.3; 2 years, 48.1 +/- 10.2; and 3 years, 46.8 +/- 9.1) showed sustained improvement posttransplant. MCS scores became similar to population norms. Functionally significant decreases in MCS and PCS scores were seen in 4%-21% and 8%-30% at times posttransplant. Male sex predicted higher scores at 4 months for the MCS (P = 0.003; regression coefficient, -8.28 [95% CI, -13.6 to -2.9]; effect size, 0.22) and PCS (P = 0.05; regression coefficient, -6.91 [95% CI, -13.9 to 0.9]; effect size, 0.08). Current psychiatric disorder at pretransplant evaluation predicted higher PCS scores at 4 months (P = 0.002; regression coefficient, -15.42 [95% CI, -24.6 to -6.2]; effect size, 0.22) and 1 year (P = 0.002; regression coefficient, -17.3 [95% CI, -27.9 to -6.7]; effect size, 0.29). Psychiatric disorder before the 12 months before the pretransplant evaluation predicted lower PCS scores at 4 months posttransplant (P < 0.001; regression coefficient, 14.98 [95% CI, 7.1-22.8]; effect size, 0.29).
Cohort size.
Although half experienced sustained quality-of-life improvement, up to one-third experienced a decrease. Past psychiatric disorder is a risk factor. Patients should be educated and monitored appropriately.
由于前瞻性研究数据较少，同时进行胰腺和肾脏移植受者的生活质量结果的风险因素知之甚少。
移植前评估和前瞻性 3 年随访。
在一所大学教学医院，由联络精神病学对连续的潜在受者进行评估。
人口统计学数据；移植前评估评分量表评分；当前、过去 12 个月和既往终身精神障碍。
36 项简明健康调查问卷（SF-36）评分。
37 例同时进行胰腺和肾脏移植的受者在移植前和移植后 4 个月接受了评估。移植后 1 年时，有 29 例（幸存者的 81%）；2 年时，有 26 例（幸存者和达到 2 年的患者的 79%）；3 年时，有 22 例（幸存者和达到 3 年的患者的 92%）接受了评估。SF-36 心理健康成分量表（MCS）评分（移植前平均为 46.8±8.2[SD]；4 个月时为 51.7±8.5；1 年时为 50.1±9.7；2 年时为 51.8±8.9；3 年时为 50.8±13.8）和生理成分量表（PCS）评分（移植前为 40.6±10.6；4 个月时为 43.6±12.0；1 年时为 45.6±11.3；2 年时为 48.1±10.2；3 年时为 46.8±9.1）在移植后持续改善。MCS 评分接近人口统计学正常值。在移植后的某些时间点，MCS 和 PCS 评分有 4%-21%和 8%-30%的显著下降。男性在 4 个月时的 MCS（P=0.003；回归系数，-8.28[95%CI，-13.6 至-2.9]；效应量，0.22）和 PCS（P=0.05；回归系数，-6.91[95%CI，-13.9 至 0.9]；效应量，0.08）的评分更高。移植前评估时的当前精神障碍预测了 4 个月时的更高的 PCS 评分（P=0.002；回归系数，-15.42[95%CI，-24.6 至-6.2]；效应量，0.22）和 1 年时的更高的 PCS 评分（P=0.002；回归系数，-17.3[95%CI，-27.9 至-6.7]；效应量，0.29）。移植前评估前 12 个月的精神障碍预测了移植后 4 个月时的较低的 PCS 评分（P<0.001；回归系数，14.98[95%CI，7.1-22.8]；效应量，0.29）。
队列规模。
尽管有一半的患者经历了持续的生活质量改善，但仍有三分之一的患者出现了下降。既往精神障碍是一个风险因素。应适当对患者进行教育和监测。
