The Investigation And Research Of QOL On Renal Transplantation Recipients And Living Donors

Objective:To investigate and research the quality of life(QOL)in renal transplantation recipients and living donors. Look for the factors that influence their QOL. And in the aim to help the patients achieving a better QOL with health education and clinical interfere which based on this research.Method:This study is a cross-sectional, descriptive design. Under the permission of the hospital ethics committee, we choose 93 renal transplantation recipients and 48 living donors as objects and 68 ESRD patients as control. Each subject was given a structural questionnaire:(1)Medical Outcomes Study Short Form-36 (MOS SF-36),to assess the QOL of subject;(2)End-stage Renal Disease Symptom Checklist-transplantation Module(ESRD-SCL):investigate the symptom of renal transplantation recipients;(3)hospital anxiety and depression questionnaire(HAD):evaluate the anxiety and depression level of the patients;(4)a self-made questionnaire which gather general information as sex,age,job and so on. Data were analyzed by Statistical Package for the Social Sciences(SPSS 11.5) for Windows software application program. Statistical methods such as t-test, Kruskal Wallis H, One-way ANOVA, Mann-Whitney U,Stepwise multiple regression and Spearman rank correlation were used to deal with data.Results:1. The renal transplant recipients showed a significantly worse QOL score on all domains of the SF-36 scales when compare with a reference general population. But as the surviving time pass by, the QOL score can be improved gradually.2. The demographic variables such as sex,family income,age,level of education,back to work or no were significantly associated with QOL。 (1) Male get better QOL scores than female in six domains of QOL except SF and BP. And in PF,RP,MH,the dominance show more significantly.(2) The total income of family members in one year showed significantly association with QOL. When whose income is more than 50,000 yuan,the patients got a significantly higher QOL score. The medical insurance has the similar influence. The patients with at public expense or local medical insurance have better QOL scores than the patients at their own expense.(3) Higer level of education also mean a higher QOL level in renal transplantation recipients.(4) Compare the patients under or exceed 40 years old,the younger get better QOL scores in four domain which linked to body health,however,the elder get better in the other four domain which linked to mental health.(5) The person who back to job score significantly higher in all domain of QOL,but she scale of patients back to work(22.6%)is much lower than aboard.3. The surviving time after transplantation surgery is association with QOL. The time with in 24 month get lower scores than the time exceed 24 month. And when we divided the surviving time,the shorter after surgery ,the lower the QOL score.4. The anxiety and depression level has a significantly influence on QOL. The patients shows anxiety and depression get much lower score than who was normal. The score is even lower than ESRD patients.5. Symptoms are also associated with QOL:the patients who have experience 10 or more symptoms score lower in all domains of QOL than the patients experience less than 10 symptoms. And the worse the symptoms,the worse the QOL. Each renal transplant recipients experienced many symptoms (mean 12,range 5-37of 97). The most frequently occurring symptoms were:fatigue (72,77.4%),dizzy and headache (63,67.7),sleeplessness (56,60.2%),mood swings (53,56.9% ),excessive appetite (49,52.6%),poorer vision (49,52.6%),increased weight (37例,39.8% ),decay in sex(35,37.6%),diarrhea (29,31.2% )。6. Compare with the reference general population,the living renal donors show no difference in most QOL domains except BP and MH. BP is slightly lower than the reference general population. And MH score more higher than norm. Meanwhile the anxiety and depression level is lower than tha norm.Conclusion:1. Compared with the norm, the renal transplant recipients showed a significantly worse QOL score on all domains of the SF-36 scales. But as the surviving time pass by,the QOL score can be improved gradually.2. The QOL of the renal transplant recipients is much better than patients with Dialysis.3. The demographic variables such as sex,family income,age,level of education,back to work or no were significantly associated with QOL。Male,younger,higher level of education,back towork and more family income were associated with better QOL.4. Symptoms are also associated with QOL:the more and the worse the symptoms,the worse the QOL. The most frequently occurring symptoms were:fatigue (72,77.4%),dizzy and headache (63,67.7),sleeplessness (56,60.2%),mood swings (53,56.9% ),excessive appetite (49,52.6%),poorer vision (49,52.6%),increased weight (37例,39.8% ),decay in sex(35,37.6%),diarrhea (29,31.2% )。5. Compare with the reference general population,the living renal donors show no difference in most QOL domains except BP and MH. BP is slightly lower than the reference general population. And MH score more higher than norm. Meanwhile the anxiety and depression level is lower than tha norm.6. Anxiety and depression is the significantly independent factor that influence the QOL.