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Table of Contents
ORIGINAL ARTICLE
Year : 2018  |  Volume : 12  |  Issue : 1  |  Page : 35-40

Health-related quality of life in postrenal transplant patients: A single-center study


1 Department of Nephrology, Mark Hospital, Bilaspur, Chhattisgarh, India
2 Department of Nephrology, Jawaharlal Nehru Medical College, Wardha, India
3 Department of Nephrology, BJMC, IKDRC/ITS, Ahmedabad, Gujarat, India
4 Department of Nephrology, Devasya Kidney Hospital, Ahmedabad, Gujarat, India
5 Department of Nephrology, Aster Aadhar Hospital, Kolhapur, Maharashtra, India
6 Department of Nephrology, Apollo Hospital, Ahmedabad, Gujarat, India

Date of Web Publication29-Mar-2018

Correspondence Address:
Dr. Manish Ramesh Balwani
Department of Nephrology, Jawaharlal Nehru Medical College, Wardha - 442 004, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijot.ijot_61_17

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  Abstract 


Background: The study was conducted to look for association of health-related quality of life (HRQoL) with renal functions in renal transplant recipients and to examine which clinical measures after renal transplantation are connected to aspects of their HRQoL. Materials and Methods: The study was carried out at IKDRC/ITS, Ahmedabad, between 2013 and 2016. Only patients who completed minimum 3 months posttransplant were included in the study. The responses were summarized and transformed to give eight summary scales which were grouped as physical component summary (PCS) and mental component summary (MCS) to give total HRQoL. Results: Out of 54 patients, 74% were males and 26% patients were females. Age distribution was between 18 and 62 years. Most common cause of end-stage renal disease was chronic glomerulonephritis (42.6%). Forty-seven patients underwent live-related kidney transplant while 7 received kidneys from cadaver. Mental health and MCS scores in males were significantly higher (<0.05) than females. With respect to age, the transplant patients were divided into four groups: younger than 30 years, 30–39 years, 40–49 years, and 50-year-old or older. No difference was found in any scale score between the age groups. The scale scores of PCS in patients with serum creatinine level >2 mg/dL were significantly lower (<0.05) than those of patients with serum creatinine <2 mg/dl. When compared in between patients who had rejection to those who did not, there was no significant difference in MCS and PCS. The scores of patients with cadaveric transplantation were similar to those who received a living-related transplantation. Longer time since the transplant operation was significantly associated with lower scores of the vitality scale. Conclusion: SF-36 V2 is a good tool to monitor HRQoL in renal transplant recipients. Episodes of hospitalization and rejection did not affect the present HRQoL in our study.

Keywords: Health-related quality of life, mental component scale, physical component scale, renal transplantation


How to cite this article:
Gautam R, Balwani MR, Kute VB, Godhani U, Ghule P, Shah P, Gumber M, Trivedi HL. Health-related quality of life in postrenal transplant patients: A single-center study. Indian J Transplant 2018;12:35-40

How to cite this URL:
Gautam R, Balwani MR, Kute VB, Godhani U, Ghule P, Shah P, Gumber M, Trivedi HL. Health-related quality of life in postrenal transplant patients: A single-center study. Indian J Transplant [serial online] 2018 [cited 2018 Jun 23];12:35-40. Available from: http://www.ijtonline.in/text.asp?2018/12/1/35/228929




  Introduction Top


Health-related quality of life (HRQoL) contains multiple aspects of health-related issues from the patients' perspective including physical, psychological, social functioning (SF) and overall well-being.[1],[2],[3] HRQoL is also increasingly recognized as an important measure of outcome following solid organ transplantation. Along with significant quantitative improvements in patient and graft survival, HRQoL has been appreciated as another valid outcome measurement. HRQoL investigations take a broad view on subjective health issues and consider health as a puzzle of singular domains of well-being. The pieces of this puzzle are psychological and social aspects of well-being in addition to physical and mental health (MH). Some of these pieces are evaluated on either a subjective or an objective basis, some domains by both dimensions.[3] Kidney transplantation is the treatment of choice for end-stage renal disease (ESRD). Advances in renal transplant procedures and immunosuppressive therapies have increased dramatically over the last decades; 1 year allograft survival rates are currently over 90%.[4] The major goal of transplantation is the achievement of maximal quality and quantity of life while minimizing the effects of disease. The units in which these sociobiological terms are reported depend on the condition that is being evaluated. Examples of these measures are quality-adjusted life years gained, disease-free life years gained, or healthy year equivalents per unit cost of care. In renal transplantation, the costs of care are not only limited to the transplant procedure but also to the evolving costs to treat adverse events, some of them caused by the immunosuppressive therapy. In parallel to better patient care and new immunosuppressive regimens, the median survival of renal allografts improved continuously.[5] Hand in hand with these achievements, greater attention has been given to long-term QoL. However, so far, HRQoL was evaluated only in a limited number of clinical trials as subjective state of health.[6],[7],[8],[9],[10],[11],[12],[13],[14],[15] It is generally accepted, however, that patients with a functioning renal allograft have an improved HRQoL as compared to patients on dialysis.[14] In this study, attempt was made to determine HRQoL of postrenal transplant recipients at a single center and to examine which clinical measures after renal transplantation are connected to aspects of their HRQoL.


  Materials and Methods Top


Data were collected on 54 out of 102 patients who underwent renal transplantation at IKDRC/ITS, Ahmedabad, who gave their consent to participate in the study. The study period was between 2013 and 2016. Subjective QoL instruments were hand-delivered at clinic visits for self-administration. Strict confidentiality was ensured. Health survey scoring system (SF-36V2) was used to assess the physical, functional, emotional, and social dimensions of QoL after renal transplantation. Patients took the SF-36 V2 at one point in time in their course, providing a cross-sectional sample. The responses were summarized and transformed into the following eight summary scales to give HRQoL: physical functioning (PF), role limitation attributable to physical problems (RP), bodily pain (BP), general health perception (GH), vitality (VT), SF, role limitation attributable to emotional problems (RE), and MH. Physical component summary score (PCS) included PF, RP, and BP whereas mental component summary (MCS) score included SF, RE, and MH. GH and VT were considered as members of both dimensions. The program which was used to calculate score is available at http://www.sf-36. org/demos/sf-36 v2.html. Nutritional assessment was performed by subjective global assessment (SGA) scale. Analysis of all the domains including the PCS and the MCS was performed. Summary data for all measures were presented throughout as means ± standard errors of the mean.


  Results Top


The demographic profile, clinical variables, and clinical parameters affecting HRQoL are shown in [Table 1]. Most of the participants were males (74%). The age distribution was between 18 and 62 years. Most common cause of ESRD was chronic glomerulonephritis (42.6%). Mean duration since posttransplant in months was 46.14 ± 42.14. Majority of participants in the study had undergone live-related kidney transplantation (47) as compared to cadaver transplantation (7).
Table 1: Demographic and clinical characteristics of the participants

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Nutritional assessment

Eight patients out of 54 (14.8%) were well nourished. Forty-five patients (83.3%) had mild malnutrition, and 1 patient (1.85%) had moderate malnutrition.

Effect of gender on health-related quality of life

MH and MCS scores in males were significantly higher (<0.05) than females as shown in [Table 2].
Table 2: Effect of age on health-related quality of life

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Effect of age on health-related quality of life

With respect to age, the participants were divided into four groups: younger than 30 years, 30–39 years, 40–49 years, and 50-year-old or older. No difference was found in any scale score between the age groups [Table 3].
Table 3: Effect of age on health-related quality of life

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Effect of serum creatinine on health-related quality of life

The transplant patients were divided into four groups according to the serum level of creatinine (>2 mg/dl, 1.5–2 mg/dl, 1–1.5 mg/dl, and ≤1 mg/dL). The scale scores of PCS in patients with a creatinine level >2 mg/dL were significantly lower (<0.05) than those of patients with creatinine <2 mg/dl [Table 4].
Table 4: Effect of serum creatinine on health-related quality of life

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Effect of history of acute rejection on health-related quality of life

Approximately 33.3% patients had an episode of clinically defined acute rejection after transplantation till the time of study. No significant impact of rejection episode was seen in patients on any scale [Table 5].
Table 5: Effect of rejection on health-related quality of life

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Effect of history of hospitalization on health-related quality of life

No significant difference on HRQoL was observed between the two groups with regard to hospitalization history [Table 6].
Table 6: Effect of hospitalization on health-related quality of life

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Effect of donor type in health-related quality of life

The scores of patients with cadaveric transplantation were similar to those who received a living-related transplantation [Table 7].
Table 7: Effect of type of transplant on health-related quality of life

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Effect of posttransplant time interval on health-related quality of life

Longer posttransplant period was associated with lower scores of the VT scale (P< 0.01) [Table 8].
Table 8: Effect of posttransplant interval on health-related quality of life

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  Discussion Top


ESRD has serious effect on the patient's QoL, negatively affecting their social, financial, and psychological well-being. QoL is a good and easy parameter to judge well-beingness of patients. Many reports are available concerning the improvement of QoL in transplant patients.[16],[17],[18],[19],[20],[21],[22],[23],[24]

Taghizadeh-Afshari et al. observed that increase in the level of education will result in increase in QoL.[25] In our study, MH and MCS scores in males were significantly higher (<0.05) than in females. This difference could be due to lesser education in participant females as compared to males.

No difference was found in any scale scores between the different age groups in our study, which is consistent with the results in other studies conducted by Taghizadeh-Afshari et al. and Vosughi and Movahedpour.[25],[26]

We found that patients with a relatively high serum creatinine level reported more problems with PCS (P< 0.05). The low score may be related to fear and uncertainty. Study by Fujisawa et al. found that low levels of serum creatinine were associated with higher scale scores.[27] They also observed that patients with a relatively high serum creatinine levels reported more problems with PF and GH.

In our study, episode of rejection in the past did not affect the scale score of the SF-36V2. In contrast, Fujisawa et al. reported the SF and RE scores of the rejection group were higher than those who had not experienced rejection.[27] We found that even if patients had experienced acute rejection, their present condition was the main factor that reflected the functioning status of the patients.

Shield et al. reported that patients with no subsequent hospitalizations demonstrated significantly greater improvement in their BP score of SF-36 compared with patients with one to two hospitalizations.[28] In addition, they also found in lesser hospitalized group a significantly better change in GH, VT, and SF compared with patients with three or more hospitalizations. However, in our study, we could not find any significant difference between the two groups. We observed that our participants were mostly concerned about their present creatinine level and remained less concerned about previous experiences such as rejection and hospitalization.

We observed that the only scale where the scores were significantly associated with the duration of posttransplant period was VT scale, which indicates that VT is reduced with longer posttransplant period after transplant surgery. Neipp et al. also observed similar findings for VT subscale but there was no significant association with other subscales.[29] The different characteristics of study populations may have caused these differences. Whenever we consider differences in HRQoL among studies, we should also look at each of the domains of HRQoL rather than the global score for HRQoL.

Despite different views regarding outcomes of cadaveric transplant among general population, there was no significant difference in this study between the QoL scores in the two types of donor recipients. Tayebi et al. report similar outcome in their study.[30] This finding is reassuring and further documents the great attractions of renal transplantation as a mode of treatment that largely restores individuals' HRQoL. Therefore, it seems necessary to hold certain programs among ESRD patients to increase their awareness about HRQoL in posttransplant cadaver recipients. It will help in better psychological acceptance of receiving organs from cadavers.

Diabetes mellitus (DM) is a major morbidity after kidney transplantation and as such warrants attention. The prevalence rate of posttransplant DM and hypertension in our study was 13% and 48.1%, respectively. Nevertheless, DM and hypertension did not show a significant influence on HRQoL. DM and hypertension are often correlated with high-dose immunosuppressant treatment, steroid treatment, or patient age. Our study could not collect data on such variables.


  Conclusion Top


In our study, we found that patients with a relatively high serum creatinine levels reported more problems with physical component scores. Mental components were significantly better in males as compared to females. Episodes of hospitalization and rejection did not affect the present HRQoL. Authors observed that SF-36 V2 is a good tool to monitor HRQoL in renal transplant recipients.

Limitations

The generalizability of the results is limited due to small sample size and being a single-center study. A larger scale study is recommended to gather more data on long-term kidney transplantation patients' HRQoL. This study used a cross-sectional design, so it could not show the trajectory of change in HRQoL. As such, a longitudinal study is recommended.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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