目的：在器官移植后，患者的生活质量以及心理状态往往都有所改善，且能够维持至少数年。这些发现主要还是处于对移植患者所谓的“平均”倾向的评估。该研究的目的在于明确是否移植受者在器官移植后会出现心理精神上良好或者不佳的不同结果。方法：我们评估了131名心脏、肺、肝脏、肾脏以及骨髓移植患者移植前、6个月、12个月和24个月的心理精神状态。我们采用聚类分析明确患者精神健康的特征(SF-36)；研究不同聚类间关于进一步心理社会参数的差异（附属感、乐观、心理社会功能、焦虑、抑郁、生活/健康舒适度、药物治疗经验）。结果：分析显示了移植患者的两个聚类。聚类A(n=78, 59.5%)显示在移植后超过2年相对良好的心理社会状态。而聚类B(n=53, 40.5%)则包含了一些移植后结果相对不佳的患者。更重要的是聚类A和B在心理社会参数以及躯体功能上存在显著差异。结果：这些发现提示不同患者之间对于移植过程的反应是不同的。虽然大多数的患者在移植后其心理社会状态确实获得改善，但是仍然有相当数量的移植受者需要心理社会支持。

Goetzmann L, Ruegg L, Stamm M, Ambühl P, Boehler A, Halter J, Muellhaupt B, Noll G, Schanz U, Wagner-Huber R, Spindler A, Buddeberg C, Klaghofer R.
Department of Psychosocial Medicine, University Hospital Zurich, Zurich, Switzerland. lutz.goetzmann@usz.ch

OBJECTIVES: Quality of life and psychosocial well-being usually improve after an organ transplant and remain stable for a minimum of several years. These findings, however, mainly apply to the "average" trend for transplant patients. This study aims to investigate whether transplant patients fall into different groups in good or poor psychosocial outcome after organ transplantation. METHODS: One hundred thirty-one patients were assessed before and 6, 12, and 24 months after a heart, lung, liver, kidney, or bone-marrow transplant. Cluster analysis was applied to identify typical outcome profiles of the patients' mental health (SF-36); differences between the clusters were investigated with regard to further psychosocial parameters (sense of coherence, optimism, psychosocial functioning, anxiety, depression, life/health satisfaction, medication experience). RESULTS: The analysis revealed two clusters of transplant patients. Cluster A (n=78, 59.5%) showed a fairly good psychosocial outcome, improving over the posttransplant period of 2 years. Cluster B (n=53, 40.5%) included patients who reported a limited or poor outcome, deteriorating after the transplant. Furthermore, there are significant differences between clusters A and B in psychosocial parameters and physical functioning. CONCLUSIONS: These findings indicate that the experience of the transplant process may vary greatly from patient to patient, and that a considerable number of transplant recipients require psychosocial support, despite the majority of patients showing an unquestionable posttransplant improvement in psychosocial well-being.