Changes in Frailty After Kidney Transplantation.
Changes in Frailty After Kidney Transplantation.
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DOI：
10.1111/jgs.13657
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发表时间：
2015-10
影响因子：
6.3
通讯作者：
Segev DL
中科院分区：
文献类型：
--
作者：
McAdams-DeMarco MA;Isaacs K;Darko L;Salter ML;Gupta N;King EA;Walston J;Segev DL
了解在积极的手术干预后衰弱的自然历史，肾移植（KT）。前瞻性队列研究（2008.12 - 2014.03）。在马里兰州的巴尔的摩。肾移植受者（N = 349）。在KT时和常规临床随访期间测量Fried衰弱评分。使用Cox比例风险模型，确定与KT后衰弱评分改善相关的因素。通过纵向分析，使用多级混合效应泊松模型确定了KT后虚弱评分变化的预测因子。在KT， 19.8%的接受者身体虚弱；术后1个月虚弱者33.3%；2个月时，27.7%虚弱；在3个月时，17.2%的人身体虚弱。平均衰弱评分恶化1个月（平均变化0.4,P < 0.001），恢复基线2个月（平均变化0.2,P = 0.07），改善3个月（平均变化- 0.3,P = 0.04）。唯一与KT后衰弱评分改善相关的受体或移植因素是KT前衰弱（风险比= 2.55,95%可信区间(CI) = 1.71-3.82, P < 0.001）。kt前虚弱状态（相对危险度RR = 1.49, 95% CI = 1.29-1.72, P < 0.001）、受体糖尿病（RR = 1.26, 95% CI = 1.08-1.46, P = 0.003）和移植物功能延迟（RR = 1.22, 95% CI = 1.04-1.43, P = 0.02）与衰弱评分的长期变化独立相关。在接受KT治疗后，所有年龄的成年受者，虚弱最初会恶化，但3个月后会改善。虽然长期来看，在KT时虚弱的KT受者的虚弱评分较高，但他们在KT后最有可能表现出生理储备的改善，这支持了这些个体的移植，并表明移植前的虚弱不是低生理储备的不可逆转状态。
To understand the natural history of frailty after an aggressive surgical intervention, kidney transplantation (KT). Prospective cohort study (December 2008–March 2014). Baltimore, Maryland. Kidney transplantation recipients (N = 349). The Fried frailty score was measured at the time of KT and during routine clinical follow-up. Using a Cox proportional hazards model, factors associated with improvements in frailty score after KT were identified. Using a longitudinal analysis, predictors of frailty score changes after KT were identified using a multilevel mixed-effects Poisson model. At KT, 19.8% of recipients were frail; 1 month after KT, 33.3% were frail; at 2 months, 27.7% were frail; and at 3 months, 17.2% were frail. On average, frailty scores had worsened by 1 month (mean change 0.4, P < .001), returned to baseline by 2 months (mean change 0.2, P = .07), and improved by 3 months (mean change −0.3, P = .04) after KT. The only recipient or transplant factor associated with improvement in frailty score after KT was pre-KT frailty (hazard ratio = 2.55, 95% confidence interval (CI) = 1.71–3.82, P < .001). Pre-KT frailty status (relative risk (RR) = 1.49, 95% CI = 1.29–1.72, P < .001), recipient diabetes mellitus (RR = 1.26, 95% CI = 1.08–1.46, P = .003), and delayed graft function (RR = 1.22, 95% CI = 1.04–1.43, P = .02) were independently associated with long-term changes in frailty score. After KT, in adult recipients of all ages, frailty initially worsens but then improves by 3 months. Although KT recipients who were frail at KT had higher frailty scores over the long term, they were most likely to show improvements in their physiological reserve after KT, supporting the transplantation in these individuals and suggesting that pretransplant frailty is not an irreversible state of low physiological reserve.