Villeneuve Claire, Laroche Marie-Laure, Essig Marie, Merville Pierre, Kamar Nassim, Coubret Anne, Lacroix Isabelle, Bouchet Stéphane, Fruit Dorothée, Marquet Pierre, Rousseau Annick
1 CHU Limoges, Department of Pharmacology, Toxicology and Centre of Pharmacovigilance, F-87000 Limoges, France. 2 INSERM, UMR-850, F-87000 Limoges, France. 3 Faculty of Medicine, University of Limoges, F-87000 Limoges, France. 4 Department of Nephrology, Dialysis and Transplantation, CHU Limoges, F-87000 Limoges, France. 5 Department of Nephrology, Transplantation, Dialysis, Centre Hospitalier Universitaire (CHU) Pellegrin, Bordeaux, France. 6 Department of Clinical Pharmacology and Toxicology, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France. 7 Bordeaux University, Bordeaux, France. 8 Department of Nephrology and Organ Transplantation, CHU Toulouse, Toulouse, France. 9 Université Paul Sabatier, Toulouse, France. 10 INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France. 11 CHU Toulouse, Laboratory of Clinical Pharmacology Toulouse, France. 12 Inserm U876, Bordeaux, France. 13 Faculty of Pharmacy, Department of Biophysics, University Limoges, F-87000 Limoges, France.
Transplantation. 2016 Mar;100(3):640-7. doi: 10.1097/TP.0000000000000846.
Health-related quality of life (HRQOL) usually improved after kidney transplantation; however, a non-negligible number of patients did not benefit from transplantation in HRQOL. The aims of this cohort study were to describe the evolution of HRQOL in kidney transplant recipients to search for subgroups with distinct time profiles and to investigate these determinants.
Three hundred thirty-seven adult patients were followed up from 1 to 36 months after kidney transplantation. Each patient completed repeated HRQOL assessments (median, 5; range, 2-9). K-means for longitudinal data was used to identify homogeneous clusters of HRQOL time profiles obtained for the mental and physical composite scores (MCS and PCS) and for the 8 dimensions of the short-form 36 scale. Covariates associated with these clusters were investigated using random forest analysis. Magnitude and shape of the HRQOL variations over time were investigated using linear regression mixed models.
Two longitudinal clusters were identified for the time profiles of PCS and MCS. Patients classified in the higher cluster (ie, 60% of the population) exhibited a steady-state HRQOL, similar on average to the general population, whereas in the lower cluster, PCS and MCS scores were significantly lower than in the general population. Muscular weakness in the first year after transplantation explained 19% of the interpatient variability of PCS 3 months after transplantation, whereas associated with anxiety, it explained 24% of interpatient MCS variability.
This work suggests to promote (i) physical rehabilitation programs after transplantation to curb the muscular loss and (ii) systematic attention to the patient's anxiety.
肾移植后与健康相关的生活质量（HRQOL）通常会有所改善；然而，仍有相当数量的患者在HRQOL方面未从移植中获益。这项队列研究的目的是描述肾移植受者HRQOL的演变，寻找具有不同时间特征的亚组，并调查这些决定因素。
对337例成年患者在肾移植后1至36个月进行随访。每位患者完成多次HRQOL评估（中位数为5次；范围为2至9次）。使用纵向数据的K均值法来识别从精神和身体综合评分（MCS和PCS）以及简短健康调查问卷36项量表的8个维度获得的HRQOL时间特征的同质聚类。使用随机森林分析研究与这些聚类相关的协变量。使用线性回归混合模型研究HRQOL随时间变化的幅度和形状。
在PCS和MCS的时间特征方面识别出两个纵向聚类。归入较高聚类的患者（即占总人群的60%）表现出稳定状态的HRQOL，平均而言与一般人群相似，而在较低聚类中，PCS和MCS评分显著低于一般人群。移植后第一年的肌肉无力解释了移植后3个月患者间PCS变异性的19%，而与焦虑相关时，它解释了患者间MCS变异性的24%。
这项研究表明应促进（i）移植后的身体康复计划以抑制肌肉流失，以及（ii）对患者焦虑的系统性关注。
