title: Evolution and Determinants of Health-Related Quality-of-Life in Kidney Transplant Patients Over the First 3 Years After Transplantation.
abstract: BACKGROUND
  Health-related quality of life (HRQOL) usually improved after kidney transplantation; however, a non-negligible number of patients did not benefit from transplantation in HRQOL. The aims of this cohort study were to describe the evolution of HRQOL in kidney transplant recipients to search for subgroups with distinct time profiles and to investigate these determinants.
  
  
  METHODS
  Three hundred thirty-seven adult patients were followed up from 1 to 36 months after kidney transplantation. Each patient completed repeated HRQOL assessments (median, 5; range, 2-9). K-means for longitudinal data was used to identify homogeneous clusters of HRQOL time profiles obtained for the mental and physical composite scores (MCS and PCS) and for the 8 dimensions of the short-form 36 scale. Covariates associated with these clusters were investigated using random forest analysis. Magnitude and shape of the HRQOL variations over time were investigated using linear regression mixed models.
  
  
  RESULTS
  Two longitudinal clusters were identified for the time profiles of PCS and MCS. Patients classified in the higher cluster (ie, 60% of the population) exhibited a steady-state HRQOL, similar on average to the general population, whereas in the lower cluster, PCS and MCS scores were significantly lower than in the general population. Muscular weakness in the first year after transplantation explained 19% of the interpatient variability of PCS 3 months after transplantation, whereas associated with anxiety, it explained 24% of interpatient MCS variability.
  
  
  CONCLUSIONS
  This work suggests to promote (i) physical rehabilitation programs after transplantation to curb the muscular loss and (ii) systematic attention to the patient's anxiety.
authors.affiliation: 1 CHU Limoges, Department of Pharmacology, Toxicology and Centre of Pharmacovigilance, F-87000 Limoges, France. 2 INSERM, UMR-850, F-87000 Limoges, France. 3 Faculty of Medicine, University of Limoges, F-87000 Limoges, France. 4 Department of Nephrology, Dialysis and Transplantation, CHU Limoges, F-87000 Limoges, France. 5 Department of Nephrology, Transplantation, Dialysis, Centre Hospitalier Universitaire (CHU) Pellegrin, Bordeaux, France. 6 Department of Clinical Pharmacology and Toxicology, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France. 7 Bordeaux University, Bordeaux, France. 8 Department of Nephrology and Organ Transplantation, CHU Toulouse, Toulouse, France. 9 Université Paul Sabatier, Toulouse, France. 10 INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France. 11 CHU Toulouse, Laboratory of Clinical Pharmacology Toulouse, France. 12 Inserm U876, Bordeaux, France. 13 Faculty of Pharmacy, Department of Biophysics, University Limoges, F-87000 Limoges, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Villeneuve
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Laroche
authors.forename: Marie
authors.initials: M
authors.lastname: Essig
authors.forename: Pierre
authors.initials: P
authors.lastname: Merville
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
authors.forename: Anne
authors.initials: A
authors.lastname: Coubret
authors.forename: Isabelle
authors.initials: I
authors.lastname: Lacroix
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bouchet
authors.forename: Dorothée
authors.initials: D
authors.lastname: Fruit
authors.forename: Pierre
authors.initials: P
authors.lastname: Marquet
authors.forename: Annick
authors.initials: A
authors.lastname: Rousseau
mesh_terms: D000328:Adult; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D016000:Cluster Analysis; D005260:Female; D005602:France; D006304:Health Status; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000523:psychology / Q000534:rehabilitation; D016014:Linear Models; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015999:Multivariate Analysis; D018908:Muscle Weakness / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome