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活体肝切除术后供体的生活质量

Quality of life of liver donors following donor hepatectomy.

作者信息

Chandran Biju, Bharathan Viju Kumar, Shaji Mathew Johns, Amma Binoj Sivasankara Pillai Thankamony, Gopalakrishnan Unnikrishnan, Balakrishnan Dinesh, Menon Ramachandran Narayana, Dhar Puneet, Vayoth Sudheer Othiyil, Surendran Sudhindran

机构信息

Department of Gastrointestinal Surgery and Solid Organ Transplant, Amrita Institute of Medical Sciences and Research Centre, Amrita University, Kochi, 682 041, India.

出版信息

Indian J Gastroenterol. 2017 Mar;36(2):92-98. doi: 10.1007/s12664-017-0743-7. Epub 2017 Apr 10.

Abstract

BACKGROUND

Although morbidity following living liver donation is well characterized, there is sparse data regarding health-related quality of life (HRQOL) of donors.

METHODS

HRQOL of 200 consecutive live liver donors from 2011-2014 performed at an Indian center were prospectively collected using the SF-36 version 2, 1 year after surgery. The effect of donor demographics, operative details, post-operative complications (Clavien-Dindo and 50-50 criteria), and recipient mortality on the quality-of-life (QOL) scoring was analyzed.

RESULTS

Among 200 donors (female/male=141:59), 77 (38.5%) had complications (14.5%, 16.5%, 4.5%, and 3.5%, Clavien-Dindo grades I-IV, respectively). The physical composite score (PCS) of donors 1 year after surgery was less than ideal (48.75±9.5) while the mental composite score (MCS) was good (53.37±6.16). Recipient death was the only factor that showed a statistically significant correlation with both PCS (p<0.001) and MCS (p=0.05). Age above 50 years (p<0.001), increasing body mass index (BMI) (p=0.026), and hospital stay more than 14 days ( p= 0.042) negatively affected the physical scores while emergency surgery (p<0.001) resulted in lower mental scores. Gender, postoperative complications, type of graft, or fulfillment of 50-50 criteria did not influence HRQOL. On asking the hypothetical question whether the donors would be willing to donate again, 99% reiterated there will be no change in their decision.

CONCLUSION

Recipient death, donation in emergency setting, age above 50, higher BMI, and prolonged hospital stay are factors that lead to impaired HRQOL following live liver donation. Despite this, 99% donors did not repent the decision to donate.

摘要

背景

尽管活体肝移植后的发病率已有充分描述,但关于供体健康相关生活质量(HRQOL)的数据却很稀少。

方法

前瞻性收集了2011年至2014年在印度一家中心进行手术的200例连续活体肝供体术后1年使用SF-36第2版的HRQOL数据。分析了供体人口统计学特征、手术细节、术后并发症(Clavien-Dindo和50-50标准)以及受者死亡率对生活质量(QOL)评分的影响。

结果

在200例供体中(女性/男性=141:59),77例(38.5%)出现并发症(Clavien-Dindo分级I-IV分别为14.5%、16.5%、4.5%和3.5%)。术后1年供体的身体综合评分(PCS)不理想(48.75±9.5),而心理综合评分(MCS)良好(53.37±6.16)。受者死亡是唯一与PCS(p<0.001)和MCS(p=0.05)均有统计学显著相关性的因素。50岁以上(p<0.001)、体重指数(BMI)增加(p=0.026)以及住院时间超过14天(p=0.042)对身体评分有负面影响,而急诊手术(p<0.001)导致心理评分较低。性别、术后并发症、移植物类型或是否满足50-50标准均不影响HRQOL。在询问供体是否愿意再次捐赠这个假设性问题时,99%的供体重申他们的决定不会改变。

结论

受者死亡、急诊情况下捐赠、50岁以上、较高的BMI以及延长的住院时间是导致活体肝移植后HRQOL受损的因素。尽管如此,99%的供体并不后悔捐赠的决定。

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