Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.
Transplantation. 2018 Feb;102(2):291-299. doi: 10.1097/TP.0000000000001943.
Health-related quality of life (HRQOL) reflects a patient's disease burden, treatment effectiveness, and health status and is summarized by physical, mental, and kidney disease-specific scales among end-stage renal disease patients. Although on average HRQOL improves postkidney transplant (KT), the degree of change depends on the ability of the patient to withstand the stressor of dialysis versus the ability to tolerate the intense physiologic changes of KT. Frail KT recipients may be extra vulnerable to either of these stressors, thus affecting change in HRQOL after KT.
We ascertained frailty, as well as physical, mental, and kidney disease-specific HRQOL in a multicenter prospective cohort of 443 KT recipients (May 2014 to May 2017) using Kidney Disease Quality of Life Instrument Short Form. We quantified the short-term (3 months) rate of post-KT HRQOL change by frailty status using adjusted mixed-effects linear regression models.
Mean HRQOL scores at KT were 43.3 (SD, 9.6) for physical, 52.8 (SD, 8.9) for mental, and 72.6 (SD, 12.8) for kidney disease-specific HRQOL; frail recipients had worse physical (P < 0.001) and kidney disease-specific HRQOL (P = 0.001), but similar mental HRQOL (P = 0.43). Frail recipients experienced significantly greater rates of improvement in physical HRQOL (frail, 1.35 points/month; 95% confidence interval [CI], 0.65-2.05; nonfrail, 0.34 points/month; 95% CI, -0.17-0.85; P = 0.02) and kidney disease-specific HRQOL (frail, 3.75 points/month; 95% CI, 2.89-4.60; nonfrail, 2.41 points/month; 95% CI, 1.78-3.04; P = 0.01), but no difference in mental HRQOL (frail, 0.54 points/month; 95% CI, -0.17-1.25; nonfrail, 0.46 points/month; 95% CI, -0.06-0.98; P = 0.85) post-KT.
Despite decreased physiologic reserve, frail recipients experience improvement in post-KT physical and kidney disease-specific HRQOL better than nonfrail recipients.
健康相关生活质量（HRQOL）反映了患者的疾病负担、治疗效果和健康状况，可通过终末期肾病患者的身体、心理和肾脏疾病特定量表进行总结。尽管肾移植（KT）后平均 HRQOL 有所改善，但变化程度取决于患者承受透析压力源的能力与耐受 KT 强烈生理变化的能力。虚弱的 KT 受者可能更容易受到这些压力源中的任何一种的影响，从而影响 KT 后的 HRQOL 变化。
我们使用肾脏疾病生活质量简表（Kidney Disease Quality of Life Instrument Short Form），在一项包含 443 名 KT 受者的多中心前瞻性队列中确定了虚弱状况以及身体、心理和肾脏疾病特定的 HRQOL。我们使用调整后的混合效应线性回归模型，根据虚弱状态量化了 KT 后短期（3 个月）的 HRQOL 变化率。
KT 时的平均 HRQOL 评分分别为身体 43.3（标准差 9.6）、心理 52.8（标准差 8.9）和肾脏疾病特定 HRQOL 72.6（标准差 12.8）；虚弱受者的身体（P < 0.001）和肾脏疾病特定 HRQOL（P = 0.001）更差，但心理 HRQOL 相似（P = 0.43）。虚弱受者的身体 HRQOL 改善率明显更高（虚弱，1.35 分/月；95%置信区间[CI]，0.65-2.05；非虚弱，0.34 分/月；95%CI，-0.17-0.85；P = 0.02）和肾脏疾病特定 HRQOL（虚弱，3.75 分/月；95%CI，2.89-4.60；非虚弱，2.41 分/月；95%CI，1.78-3.04；P = 0.01），但 KT 后心理 HRQOL 无差异（虚弱，0.54 分/月；95%CI，-0.17-1.25；非虚弱，0.46 分/月；95%CI，-0.06-0.98；P = 0.85）。
尽管生理储备减少，但虚弱的 KT 受者在 KT 后身体和肾脏疾病特定的 HRQOL 改善方面的效果要好于非虚弱受者。
