Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands.
Nephrol Dial Transplant. 2021 Dec 2;36(12):2327-2339. doi: 10.1093/ndt/gfab232.
Health-related quality of life (HRQOL) is becoming an increasingly important outcome in kidney transplantation (KT). To describe HRQOL in kidney transplant recipients (KTRs), this systematic review summarizes literature that compared HRQOL among KTRs and other relevant populations [i.e. patients receiving dialysis, patients on the waiting list (WL) for KT, patients with chronic kidney disease (CKD) not receiving renal replacement therapy (RRT), the general population (GP) and healthy controls (HCs)] and themselves before KT.
The literature search was conducted in PubMed, Embase, Web of Science and the Cochrane Library. Eligible studies published between January 2000 and October 2020 were included.
Forty-four studies comprising 6929 KTRs were included in this systematic review. Despite the study heterogeneity, KTRs reported a higher HRQOL after KT compared with pre-transplantation and compared with patients receiving dialysis with or without being on the WL, especially in disease-specific domains (i.e. burden and effects of kidney disease). Additionally, KTRs had similar to marginally higher HRQOL compared with patients with CKD Stages 3-5 not receiving RRT. When compared with HCs or the GP, KTRs reported similar HRQOL in the first 1 or 2 years after KT and lower physical HRQOL and lower to comparable mental HRQOL in studies with longer post-transplant time.
The available evidence suggests that HRQOL improves after KT and can be restored to but not always maintained at pre-CKD HRQOL levels. Future studies investigating intervention targets to improve or maintain post-transplant HRQOL are needed.
健康相关生活质量（HRQOL）在肾移植（KT）中变得越来越重要。为了描述肾移植受者（KTR）的 HRQOL，本系统评价总结了比较 KTR 与其他相关人群（即接受透析的患者、等待 KT 的患者、未接受肾脏替代治疗（RRT）的慢性肾脏病（CKD）患者、普通人群（GP）和健康对照（HCs））和他们自己在 KT 之前的 HRQOL 的文献。
文献检索在 PubMed、Embase、Web of Science 和 Cochrane Library 中进行。纳入 2000 年 1 月至 2020 年 10 月期间发表的符合条件的研究。
本系统评价共纳入 44 项研究，包括 6929 名 KTR。尽管存在研究异质性，但 KTR 在 KT 后报告的 HRQOL 高于移植前，并且与接受透析的患者（无论是否在 WL 上）相比，尤其是在疾病特异性领域（即肾脏疾病的负担和影响）。此外，与未接受 RRT 的 CKD 3-5 期患者相比，KTR 的 HRQOL 相似或略高。与 HCs 或 GP 相比，KTR 在 KT 后 1 或 2 年内报告了相似的 HRQOL，而在移植后时间较长的研究中，KTR 的身体 HRQOL 较低，心理 HRQOL 较低或相似。
现有证据表明，KT 后 HRQOL 有所改善，并且可以恢复到但不一定能维持在 CKD 前的 HRQOL 水平。需要进一步研究干预目标，以改善或维持移植后的 HRQOL。
