Effects of Recipient Age and Diagnosis on Health-related Quality-of-Life Benefit of Lung Transplantation
Effects of Recipient Age and Diagnosis on Health-related Quality-of-Life Benefit of Lung Transplantation
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DOI：
10.1164/rccm.201501-0126oc
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发表时间：
2015-10-15
影响因子：
24.7
通讯作者：
Tomlinson, George
中科院分区：
文献类型：
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作者：
Singer, Lianne G.;Chowdhury, Noori A.;Tomlinson, George
理由：肺移植受者的平均年龄在增加，移植受者适应症的组合正在发生变化。目标：确定肺移植的健康相关生活质量（HRQL）益处是否因受者年龄和诊断而异。方法：在这项前瞻性队列研究中，我们对随后接受肺移植（2004-2012）的晚期肺病成人进行了系列 HRQL 测量。 HRQL 评估包括圣乔治呼吸问卷、36 项简短健康调查 (SF-36)、EQ-5D、标准赌博和当前健康状况视觉模拟量表。我们使用线性混合效应模型来研究年龄或诊断与 HRQL 变化与移植之间的关联。为了解决潜在的生存偏差，我们将马尔可夫模型拟合到离散的移植后健康状态的分布（HRQL 比移植前更好、不是更好或死亡），并估计移植后的质量调整生命年。测量和主要结果：总共列出了 430 名受试者，其中 387 名接受了移植，326 名提供了移植前和移植后数据。移植使所有 HRQL 指标都有很大改善：圣乔治改变了 47 个单位（95% 置信区间，-48 至 -44），36 项简短健康调查身体成分总结分数为 17.7（16.5-18.9），EQ-5D 为 0.27（0.24-0.30），标准赌博为 0.48（0.44-0.51），和 44 (42-47) 的视觉模拟。年龄与移植的 HRQL 益处的有意义差异无关。间质性肺疾病的 HRQL 获益低于囊性纤维化。结论：肺移植带来较大的 HRQL 获益，该获益因受者诊断而异，但在老年受者中没有显着差异。
Rationale: The average age of lung transplant recipients is increasing, and the mix of recipient indications for transplantation is changing.Objectives: To determine whether the health-related quality-of-life (HRQL) benefit of lung transplantation differs by recipient age and diagnosis.Methods: In this prospective cohort study, we obtained serial HRQL measurements in adults with advanced lung disease who subsequently underwent lung transplantation (2004-2012). HRQL assessments included the St. George's Respiratory Questionnaire, 36-Item Short-Form Health Survey (SF-36), EQ-5D, Standard Gamble, and Visual Analog Scale for current health. We used linear mixed effects models for associations between age or diagnosis and changes in HRQL with transplantation. To address potential survivorship bias, we fitted Markov models to the distribution of discrete post-transplant health states (HRQL better than pretransplant, not better, or dead) and estimated quality-adjusted life-years post-transplant.Measurements and Main Results: A total of 430 subjects were listed, 387 were transplanted, and 326 provided both pretransplant and post-transplant data. Transplantation conferred large improvements in all HRQL measures: St. George's change of 47 units (95% confidence interval, -48 to -44), 36-Item Short-Form Health Survey physical component summary score of 17.7 (16.5-18.9), EQ-5D of 0.27 (0.24-0.30), Standard Gamble of 0.48 (0.44-0.51), and Visual Analog of 44 (42-47). Age was not associated with meaningful differences in the HRQL benefits of transplantation. There was less HRQL benefit in interstitial lung disease than in cystic fibrosis.Conclusions: Lung transplantation confers large HRQL benefits, which vary by recipient diagnosis, but do not differ substantially in older recipients.