Relationship between pre-transplant physical function and outcomes after kidney transplant
Relationship between pre-transplant physical function and outcomes after kidney transplant
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DOI：
10.1111/ctr.12952
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发表时间：
2017-05-01
影响因子：
2.1
通讯作者：
LeBrasseur, Nathan K.
中科院分区：
文献类型：
--
作者：
Lorenz, Elizabeth C.;Cheville, Andrea L.;LeBrasseur, Nathan K.
背景：基于表现的身体功能测量可预测非移植手术后的发病率。研究目标是确定身体机能是否可以预测肾移植后的结果，并评估移植后身体机能如何变化。 方法：我们于 2012 年 5 月至 2014 年 2 月在我们中心进行了一项涉及活体肾移植受者的前瞻性研究。使用短体力测试电池（SPPB [平衡、椅子站立、步态速度]）和握力测试来测量身体机能。对初始住院时间 (LOS)、30 天再住院、同种异体移植功能和生活质量 (QOL) 进行了评估。结果：我们队列中的 140 名患者中的大多数具有良好的移植前身体功能。一般来说，平衡评分比 SPPB 更能预测移植后的结果。移植前平衡降低与较长的 LOS 和增加的再住院次数独立相关，但与移植后的 QOL 无关；移植后 4 个月，35% 的患者步态速度出现有临床意义的改善 (>= 1.0 m/s)。 结论：身体功能下降可能与肾移植后较长的 LOS 和再住院有关。需要进一步的研究来证实这种关联。在我们的队列中，移植前步态速度和结果之间缺乏关系可能代表上限效应。风险分层可能需要更全面的措施，包括平衡测试。
Background: Performance-based measures of physical function predict morbidity following non-transplant surgery. Study objectives were to determine whether physical function predicts outcomes after kidney transplant and assess how physical function changes post-transplant.Methods: We conducted a prospective study involving living donor kidney transplants recipients at our center from May 2012 to February 2014. Physical function was measured using the Short Physical Performance Battery (SPPB [balance, chair stands, gait speed]) and grip strength testing. Initial length of stay (LOS), 30-day rehospitalizations, allograft function, and quality of life (QOL) were assessed.Results: The majority of the 140 patients in our cohort had excellent pre-transplant physical function. In general, balance scores were more predictive of post-transplant outcomes than the SPPB. Decreased pre-transplant balance was independently associated with longer LOS and increased rehospitalizations but not with post-transplant QOL; 35% of patients experienced a clinically meaningful (>= 1.0 m/s) improvement in gait speed 4 months post-transplant.Conclusions: Decreased physical function may be associated with longer LOS and rehospitalizations following kidney transplant. Further studies are needed to confirm this association. The lack of relationship between pre-transplant gait speed and outcomes in our cohort may represent a ceiling effect. More comprehensive measures, including balance testing, may be required for risk stratification.