活体供肾移植后多维健康相关生活质量的趋势和预测因素。

Trends and predictors of multidimensional health-related quality of life after living donor kidney transplantation.

机构信息

Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 Michigan Ave, 21st Floor, Chicago, IL, 60611, USA.

Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center, Feinberg School of Medicine, Chicago, IL, USA.

出版信息

Qual Life Res. 2020 Sep;29(9):2355-2374. doi: 10.1007/s11136-020-02498-2. Epub 2020 Apr 13.

DOI:10.1007/s11136-020-02498-2

PMID:32285345

Abstract

PURPOSE

Living donor kidney transplant (LDKT) imparts the best graft and patient survival for most end-stage kidney disease (ESKD) patients. Yet, there remains variation in post-LDKT health-related quality of life (HRQOL). Improved understanding of post-LDKT HRQOL can help identify patients for interventions to maximize the benefit of LDKT.

METHODS

For 477 LDKT recipients transplanted between 11/2007 and 08/2016, we assessed physical, mental, social, and kidney-targeted HRQOL pre-LDKT, as well as 3 and 12 months post-operatively using the SF-36, Kidney Disease Quality of Life-Short Form (KDQOL-SF), and the Functional Assessment of Cancer Therapy-Kidney Symptom Index 19 item version (FKSI-19). We then examined trajectories of each HRQOL domain using latent growth curve models (LGCMs). We also examined associations between decline in HRQOL from 3 months to 12 months post-LDKT and death censored graft failure (DCGF) using Cox regression.

RESULTS

Large magnitude effects (d > 0.80) were observed from pre- to post-LDKT change on the SF-36 Vitality scale (d = 0.81) and the KDQOL-SF Burden of Kidney Disease (d = 1.05). Older age and smaller pre- to post-LDKT decreases in serum creatinine were associated with smaller improvements on many HRQOL scales across all domains in LGCMs. Higher DCGF rates were associated with worse physical [e.g., SF-36 PCS hazard ratio (HR) 1.18; 95% CI 1.01-1.38], mental (KDQOL-SF Cognitive Function HR 1.27; 95% CI 1.00-1.62), and kidney-targeted (FKSI-19 HR: 1.18; 95% CI 1.00-1.38) HRQOL domains.

CONCLUSION

Clinical HRQOL monitoring may help identify patients who are most likely to have failing grafts and who would benefit from post-LDKT intervention.

摘要

目的

对于大多数终末期肾病（ESKD）患者而言，活体供肾移植（LDKT）可带来最佳的移植物和患者存活率。然而，LDKT 后的健康相关生活质量（HRQOL）仍存在差异。更好地了解 LDKT 后的 HRQOL 有助于确定需要干预的患者，以最大限度地提高 LDKT 的获益。

方法

我们评估了 477 例于 2007 年 11 月至 2016 年 8 月期间接受 LDKT 的患者在 LDKT 前、术后 3 个月和 12 个月的身体、心理、社会和肾脏靶向 HRQOL，使用 SF-36、肾脏病生活质量简表（KDQOL-SF）和癌症治疗功能评估-肾脏症状指数 19 项版本（FKSI-19）进行评估。然后，我们使用潜在增长曲线模型（LGCM）检查每个 HRQOL 域的轨迹。我们还使用 Cox 回归分析了 LDKT 后 3 个月至 12 个月期间 HRQOL 下降与死亡相关移植物失败（DCGF）之间的关系。

结果

从 LDKT 前到后，SF-36 活力量表（d=0.81）和 KDQOL-SF 肾脏疾病负担量表（d=1.05）的变化均观察到较大的效应量（d>0.80）。在 LGCM 中，年龄较大和术前至术后血清肌酐下降幅度较小与大多数 HRQOL 量表在所有领域的改善较小有关。更高的 DCGF 发生率与较差的身体（例如，SF-36 PCS 风险比[HR]1.18；95%CI 1.01-1.38）、心理（KDQOL-SF 认知功能 HR 1.27；95%CI 1.00-1.62）和肾脏靶向（FKSI-19 HR：1.18；95%CI 1.00-1.38）HRQOL 领域相关。