Health-related quality of life score after transplant predicts associated benefit, risk
Click Here to Manage Email Alerts
Health-related quality of life scores after kidney transplantation varied between patients who survived for at least 3 years and those who died during this time, leading researchers to suggest such tools may help identify at-risk patients.
“The post-transplant [health-related quality of life] HRQoL alterations followed distinct patterns among different patient groups. Recipients surviving for at least 3-years, improved substantially in almost all HRQoL domains, while recipients who died within 36 months post-transplant experienced no improvement during the first year,” Vasiliki Tsarpali, MSc, of Telemark Hospital Trust and the University of Oslo, and colleagues wrote. “These findings are novel and imply that post-transplant HRQoL measurements may identify older recipients at risk for adverse outcomes.”
For the study, researchers compared HRQoL scores taken during the last 6 months prior to kidney transplantation with those obtained 1 year and 3 years after transplant in 136 recipients who survived to this point (for the recipients who died during the study period, pre-transplant scores were compared only with scores obtained in the first year following transplantation). All participants were at least 65 years old.
HRQoL was measured with the generic SF-36 survey that assessed physical function and emotional function, as well as with a kidney-specific survey assessing symptoms, burden of kidney disease, work status, cognitive function, quality of social interaction, sexual function, sleep, social support, dialysis staff encouragement and patient satisfaction. In addition, researchers assessed five measures regarding issues after transplantation, including the extent to which expectations prior to transplantation were met, perception of graft function, psychological impact, adverse effects of immunosuppression and whether the participant would again choose transplantation as the “preferred treatment.”
For survivors, responses showed improvement in all the generic and kidney-specific HRQoL domains, with the benefit persisting for 3 years.
“The increase in the domains of general health, vitality, effect, and burden of kidney disease was clinically significant,” the researchers wrote. “The score of total health increased early and remained stable throughout the [third] year.”
On the other hand, recipients who died between 12 and 36 months had similar HRQoL at 1 year following transplant as they had prior to transplantation which suggests, according to Tsarpali and colleagues, there is a possible association between “impaired” HRQoL after transplant and a risk for adverse outcomes.
Findings also demonstrated that longer time on dialysis and elevated comorbidity scores prior transplantation were associated with sustained physical deterioration after transplantation.
“The lack of HRQoL improvement in the deceased recipients warrants cautious interpretation, since the analysis is based on few observations and is not adjusted for post-transplant events that might have accounted for the observed outcome,” the researchers wrote.
Despite this, Tsarpali and colleagues “support the implementation of regular post-transplant HRQoL measurements in the follow-up of older recipients, which may prove useful in identifying individuals at risk for impaired outcomes.”
Collapse
Read more about
Click Here to Manage Email Alerts